Do I need skin graft to solve the ectropion after eye bag removal? (Photo)

I am 7 weeks after the surgery.. it still the eyelid a way from the eye ball .. I continuing massaging and see the doctor .. he said he can make some stichs in the bone to make the eyelid return to position .. but he said I have to wait until 3 months or more .. to see the progress of massage and the full healing.. and he said put the suggestion of skin graft at the last choice and I have to be patient to have good result .. l am 29 years old

Doctor Answers 7

Left lower lid post blepharoplasty retraction/ ectropion

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Hi there. Greetings from the UK! Yes you do have a mild left lower lid ectropion/ retraction following your blepharoplasty procedure. It typically occurs as a result of uncorrected gravitational tension on the eyelid. It may be temporary due to the eyelid being heavy due to postoperative swelling but as you're probably worrying it may be permanent. I typically try to tighten the lateral canthal tendon to try and prevent this complication in the first place and also combine it with an orbicularis suspension to add extra upward vector to the anterior layer of the eyelid and also am very conservative when it comes to skin excision. My recommendations are that you really need to talk to your surgeon to ensure you know exactly what was performed in the first place. If you have faith in him/ her correcting this problem then great but if not I'd recommend that you see an oculoplastic surgeon. He/ she would try to avoid a skin graft if possible as they may not look great cosmetically and you may get away with correcting any horizontal laxity of the eyelid and supporting the eyelid with extra upward vectorial pull. As you say you may need elongation of the eyelid with a skin graft ultimately but some surgeons get away with tissue recruitment by trying to elevate the midface a la Madame Butterfly procedure as popularised by Norman Shorr... Good luck. Best wishes David.

Birmingham Oculoplastic Surgeon

Skin Graft after Bag removal

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Thank-you for your question. As long as your cornea remains healthy and you do not develop a  left dry eye, I would advise continuing the massage recommended by your doctor for at least 3-6 months. After that period of time, if the ectropion remains, I would suggest that you seek consultation with an Oculoplastic Surgeon. A number of reconstructive options exist  . He/she will be able to advise you on what would be the best option. I agree that a skin graft would be the last option.

Edward H. Bedrossian, Jr., MD
Philadelphia Oculoplastic Surgeon

The repair proposed by your surgeon will not work.

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I have pioneers the definitive method of correcting these issues.  You have a weak orbital rim that can't support the lower eyelid.  The mechanism of your lower eyelid malposition is motor injury caused by your lower blepharoplasty.  Putting a stitch in the corner to the bone (lateral canthoplasty) will actually pull the lower eyelid down further.  A skin graft could fix this but it is horrible ugly.  For this reason, specialized lower eyelid reconstructive methods have been developed to address this problem.  It involves lengthening the retracted lower eyelid using a graft from the roof of the mouth.  Also there is weakness in the orbital rim, and I find that an orbital rim implant to support the weight of the cheek is invaluable.  My free ebook on eyelid surgery cited below has much more detail on this repair.  You should be 4 to 6 months out from your original surgery before having this revision.  Do not get a lower eyelid skin graf.  Do not let your surgeon put a stitch in to the bone because they are going to use up important resources needed for ultimately reconstructing this eyelid.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lateral Retraction

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Based on the photograph, you have a mild lateral lower eyelid retraction. It may be related to scarring, which may need a skin graft, but in cases of post-lower eyelid blepharoplasty, it can also be related to volume loss from fat removal. I would suggest waiting for the time being since it is still relatively early in the recovery period, but if it does not gradually improve, you should have an evaluation with an oculoplastic surgeon as there are many options for treatment including lateral tightening so as to potentially avoid using a skin graft.

Mahsa Sohrab, MD
New Haven Oculoplastic Surgeon

Eyelid retraction

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do not let anyone do a skin graft to your lower eyelid now.  I recommend waiting at least 6 months if there is no corneal exposure issue such as excess tearing, redness, or pain.  Often the eyelid retraction will improve with massage and time.  At that point reevaluate with your surgeon and if here is continued retraction surgical options can be considered.  From the pictures I think the retraction is related to excess horizontal lid length and lid laxity.  If, and only if, the retraction does not improve, then I believe tightening the lower kid with a canthopexy would be appropriate.

Ectropion after lower blepharoplasty

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You may need skin graft to correct the ectropion. But best to see an oculoplastic surgeon for evaluation.  See following link.

Do I have to have a skin graft to repair my lower eyelid after surgery?

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I would suggest to continue massaging the incision area as it will continue to mature over the next few more months.  Sometimes injections of 5FU (off-label) and Kenalog can help soften the incision and lessen the contraction and down pull on your eyelid.  The suggestion of a few sutures to raise the eyelid at the outer corner is often helpful and restorative in returning the eyelid to its proper position.  Also sometimes the cheek needs to be raised/supported a small amount that can be done through a crows feet incision.  I've also had some success with a rotation mattress suture technique in conjunction with raising the lateral canthus (outer corner of eyelids) to help further pull in and up the eyelid.  Lastly would do a skin graft, but this is often not needed.  Don't give up as massage and time can do wonders for the healing.  Keep in touch with your surgeon, who wants you to have the best outcome possible.  Best regards.

John R. Burroughs, MD
Colorado Springs Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.