Do I need skin graft to solve the ectropion after eye bag removal? (Photo)
Doctor Answers 7
Left lower lid post blepharoplasty retraction/ ectropion
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.
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.
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.
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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.