Unable to Close Eyes 6 Years After Bleph - Help Please? (photo)

Had Trans Quad Bleph - I was 30. didn't research. Saw a dr for small bags (which I now know could've been sorted with filler). He said that I needed the full eye job. Since, I have been unable to sleep with my eyes fully closed. My eyes twitch when I blink. I have spent a fortune on consultations with occuplasts and have to use eye drops overnight. Lids r approx 3mm shorter than normal sz. Other surgeons opinion: skin graft is unsightly. One suggested fat transfer to upper lid. would this help?

Doctor Answers 6

Unable to close eyes 6 years after blepharoplasty

Thank you for the question and the photos. The problem you are having now is a cosmetic rather than functional. You do not mention anything about visual problems which one can assume after six years it should be fine. There is no easy answer here except for ding skin graft; a thing you object. fat graft has been suggested but not sure what that will do. Placement of gold weight in the upper lid may not help due shortening of the outer lamella and you may not like the shape. So I think if do not have visual problems just leave it. and overtime as the brow starts to drop with time and gravity it will give you better closure. Best wishes.

San Diego Plastic Surgeon
5.0 out of 5 stars 15 reviews

Unable to Close Eyes after Blepharoplasty?

I'm very sorry to hear about the complication you have experienced  after blepharoplasty surgery. As you have learned,  there is no simple fix. Based on the consultations you have already had, I think you have learned about all the available options.

Keep in mind, that sometimes the  down sides of surgical options may be unacceptable and nonsurgical treatment ( for example prevention of dry eyes etc.”)  makes sense. In other words, please make sure that you do not take  a bad problem and potentially make it worse.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Unable to close eyes

If after 6 years your eyes will not close, you will not get any more improvement with time.  One way to possibly improve this is with skin grafts.  Best to be seen in person to make an accurate assessment.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Eyelid surgery, unable to close eyes

After 6 years it is very unlikely that your eyelids will stretch on their own except over many years. It is possible that fat grafting would help with eyelid closure, but it would very likely change your appearance in an unattractive way. Skin grafts would be unacceptable cosmetically.  I do think stretching with exercises on vigorous eye closure many times a day, and stretching the eyelids by pulling down on them manually may make some mild difference.  You could do a small lateral tsarroraphy ( partially sewing the lateral edges together) which would help with eyelid closure, and if done very carefully would not substantially change your eyelid appearance. It is a diffcult problem, and points out the harm that can be done with an overly aggressive eyelid procedure.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 95 reviews

I don't believe that you will find acceptable repair for this in the UK or on the Continent.

Dear Pocahantas

Both fat grafting and skin grafts would be a disaster.  You should work with your general ophthalmologist to work with the options available for dry eye: artificial tears, night time ointment, punctual occlusion, Restasis, high water content contact lens, etc.  Unfortunately you photos are not a substitute for an actual examination.  It appears that you have stretch back of the thin upper eyelid skin into the sub brow area.  This suggests a very aggressive upper blepharoplasty.  However, it is not simply the removal of skin that is causing your issue.  No, the real problem is loss of upper eyelid orbicularis oculi muscle function.  This muscle closes the eye.  You blepharoplasty damaged the motor nerves to this muscle and this muscle does not appear to function based on the photos.


So if fat and skin grafting are not ideal, what do we do?  Well it very much depends on your precise issues.  Sometimes the answer is to lift the lower eyelid and mid face a few millimeters to permit the lower eyelid to reach the upper eyelid margin when the eyes are closed.  Another option in very dry eyes that can not be managed medically is to reconstruct the upper eyelids with with the skin graft and sometimes a gold weight.  Unfortunately these later options are not at all cosmetic and need to be regarded as a last resort.  I recommend that you proceed carefully. 

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

Sometimes the best treatment is nothing.

If there is no functional problem with your eyes (irritation, dry cornea), perhaps the best treatment is nothing.  The pictures don't look that bad to me.  The twitching sounds like blepharospasm and might be treated with Botox.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 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.