Less-than-ideal cosmetic results and complications for life (dry eyes and lagophthalmos)

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I am 37, and I had upper and lower...

I am 37, and I had upper and lower (transcutaneous) blepharoplasty about 7 weeks ago. Below is a summary of the complications I have encountered. I'm putting this out there because I'd love to "compare notes" in comments with other folks who have had similar experiences.

Painful Stitch -- Immediately post-op (before even leaving the surgery center), I had an intense feeling of something poking/scratching in the outer corner of one of my eyes. It felt like a stitch or perhaps a snipped eyelash might have been scratching either the surface of my eye or the inner surface of my eyelid. I mentioned this right away to the nurse, but I was told it was probably just dryness and to use eye drops. This intense pain lasted for the first few days, and then it would come and go. I had my stiches removed a week after my surgery, but still experienced the pain, periodically. In my Week 3 follow-up appointment, the doctor found and removed a stitch with a knot out of that same corner of my eye, and I’m pretty sure that was what was causing the pain because it never returned after that.

Lagophthalmos – During the entire first week after my surgery (and even well into the second week), I could not close either of my eyes without really clenching hard to force them shut. This was extremely scary. My right eye was much worse than my left. This meant that I could not close my eyes when sleeping or blinking, and it caused EXTREME dryness and pain for me in my first week. This, combined from the pain from the “rogue” stitch was almost unbearable during the first few days.
I was told to put ointment (e.g. Refresh PM) in my eyes to protect them at night and use preservative-free artificial tears (the kind that come in individual vials) during the day. The preservative-free artificial tears did seem to be a little better than the ones I had been using, but did not provide complete relief. Also, the ointment at night did not help me at all, and even made matters worse. The sensation was as if the ointment itself would dry out and start leeching the already-scarce moisture from my eyes. Eventually, I found a solution on my own. I began using artificial tears before going to bed, put plastic wrap over my eyes, and then used a fabric sleep mask over the plastic wrap to help hold it in place. The plastic wrap created a moisture chamber so that my eyes wouldn’t dry out at night.
I am 7 weeks post-op, and although I can finally close my eyes with relative ease, they still only partially blink (unless I consciously blink all the way), and they don’t stay closed when I sleep. So I still have to use my plastic wrap solution every single night. It sort of makes me feel like a freak.

Dry Eyes – From Day 1 all the way until now (Week 7), I have been having problems with dry eyes. I’m not sure whether this is solely due to the lagophthalmos, or if there is some other factor (e.g., tear production?) involved. I doubt it is due to swelling because most of that has subsided. Anyhow, today, at Week 7, I am still using artificial tears almost every hour, have trouble with my contact lenses, and my eyes are constantly uncomfortable and red. This is really pretty terrible, and I’m worried that I will have to deal with dry eyes for the rest of my life. Although I like my cosmetic results, I am teetering on regretting having this procedure done because of this.

Chemosis – The clear conjunctiva which covers the sclera (the white of my eye) became swollen in both eyes immediately following surgery. When I would look inwards towards my nose, the conjunctiva would “bunch up” between my iris (the blue-colored part of my eye) and the lacrimal caruncle (the little pink triangle in the inner corner of the eye). I’ve been given a steroid/antibiotic drop to address this. The drops have helped, but as of Week 7, it still hasn’t completely resolved.

Random stitches – I had my stitches removed a week after my surgery, but every now and then, a piece of leftover stitch would poke through my skin. Most of these stitches have been the “dissolvable” kind. Even now in the 7th week, I just found another rogue stitch almost 1/4” long poking through at the outside corner. It was easy to just pull out myself with tweezers. It too was the “dissolvable” kind.

Loss of sensation – This is something I was never very worried about, but in the first few weeks after my surgery, I had a loss of sensation below my right eye. If I touched the area about one inch below my eye, it would feel like I was running my finger along the bottom of my eyeball. It was not scary or painful – just weird. At Week 7, most of this has resolved, but it still feels a little weird if I try to put on eyeliner.

A couple more things I forgot to mention in my original post...

Here are two more things I forgot to mention in my original post:

Mild lower lid retraction -- I started to see slight lower lid retraction in both eyes. I've been instructed to use massage to help with the tightness/retraction. Although I've been slightly more aggressive with it than instructed, I'm still not sure whether it's helping. Time will tell, I guess.

Bruised upper eyelid -- After all my bruises from surgery had completely healed (3 weeks post-op), I ended up bruising my upper eyelid pretty bad when attempting to remove some makeup. I was using one of those Simple Facial Cleansing wipes, and I must have scrubbed too hard and broken a fragile blood vessel. Blood pooled under the skin for the first couple days and gradually spread into a bruise that covered my entire upper eyelid. It took about 3 weeks for it to completely go away.

Before and After Pictures

Here are a few before and after pictures. You can also see other pictures I've taken of some of my complications if you select my name to see my other posts.

At almost 4 months post-op, I'm getting some relief from dry eye treatment

At nearly 4 months out from surgery, I'm starting to get some dry eye relief from punctal plugs and Restasis. I have punctal plugs in both the top and bottom puncta, and I've been on Restasis for about 5 weeks. I've been told it takes about 6 weeks for Restasis to start working, so that seems about right. For the first time since my surgery, I was able to wear my contacts all day for several days last week. The left eye felt fine with contacts, and the right eye was irritated, but it was tolerable. While I'm happy that my eyes are feeling better, it's awful to know that I may need to rely on Restasis for the rest of my life. It is $400 for a 30 day supply, and there is no generic equivalent.

Unfortunately, I'm still having to sleep with plastic wrap over my eyes every night due to lagophthalmos (poor lid closure). I hope that gets better someday.

4 Month (+ 1 week) Update

I would just like to say that I think my cosmetic results are stunning (new before/after picture attached). I actually enjoy seeing myself in the mirror now, and sometimes I even catch myself admiring them a bit too often. Is this what narcissism feels like? ;-)

That said, I'm still having a lot of trouble with dry eyes. Even with treatment, my right eye is still a bit dry and gives me problems when I wear my contacts. My left eye feels pretty good *most* of the time now, but sometimes it waters too much, and other times it feels too dry. The dry eye treatments I've been on (Restasis and punctal plugs) are helping immensely, but it's a drag that I'll probably have to rely on them for the rest of my life. I'm glad I'm not having to constantly use artificial tears any longer though.

I'm also still having a bit of trouble keeping my eyes closed all the way through the night, but that's getting a little better. I can usually make it about 3-4 hours in relative comfort without the plastic wrap, but any longer than that, and it becomes painful. If I try to make it through the whole night without the plastic wrap, it pretty much wrecks me for the whole next day: My eyes will feel very dry and uncomfortable.

4 1/2 Month Update and Information for Folks Considering Blepharoplasty

Note: The information below is what I sent to another RealSelf member who was considering blepharoplasty and had some questions for me:

I still haven't decided whether the procedure was worth it or not for me. Currently, I still struggle with dry eye discomfort every day despite the treatments I'm on (punctal plugs, Restasis, plastic wrap at night). I think that if I ever got to the point where I no longer experienced any discomfort and no longer required the Restasis, then it would be totally worth it. That may never happen for me though.

I’m unclear on whether it was the surgery on my lower lids or upper lids (or both) that caused my eye closure issues. I think that the swelling and tightness from both procedures contributed initially. 4 ½ months later, I can close my eyes fairly easily, so it seems like she didn’t take too much skin. But for some reason, my eyes still don’t stay closed after I fall asleep. I’m hopeful that that will improve with time as the tissues relax.

It is definitely NOT normal for someone to have dry eyes this long after surgery. I think people usually feel great after about 3 weeks. What’s weird is that I *never* had problems with dry eyes until after my surgery. Now my eyes feel dry/uncomfortable whether I have my contacts in or not. I’m currently working with two different doctors (my oculoplastic surgeon, who did the surgery, and a cornea specialist), and neither one seems to understand exactly why I’m having such a tough time. Some of their theories include:
1. I might have had an underlying dry eye condition and symptoms weren’t exposed until after surgery.
2. I might have had an incomplete blink/nocturnal lagophthalmos prior to surgery, and surgery made it worse.
3. My system might have responded to surgery by going into “tear shut-down mode.” Note that I have done a TON of research, and I haven’t found any information about this happening to anyone else.
4. My eye is slightly more open now due to mild lower lid retraction, and that might be causing more tear evaporation.
5. I likely have a combination of these factors.

Here are some things I wish I had known prior to surgery:
1. Lower blepharoplasty is associated with a lot more complications than upper blepharoplasty.
2. Transcutaneous lower blepharoplasty is associated with more complications than transconjunctival blepharoplasty. Note that I had the transcutaneous method (where the incision is on the outside of the lower lid). I wish that I had asked about the transconjuctival approach (where the incision is on the inside of the lower lid) because this method is supposed to better preserve the integrity of the muscle and nerves below the surface. Even if you have excess skin, the transconjuctival approach can still be used with a skin pinch to remove any excess skin.
3. Even if you don’t have any symptoms of dry eye (I didn’t until after surgery), get tested for any pre-existing dry eye conditions. There are a couple of different tests they can do to evaluate tear production and tear quality. You might also ask your surgeon to observe you and make sure you have a complete blink beforehand.

I hope all this information helps you as much as it might have helped me. Even though this surgery might never be “worth it” for me, I wouldn’t discourage someone else from trying it because I think I am one of those rare cases where things just didn’t go right. I don’t think my surgeon did anything wrong, I think my body has just reacted abnormally. It’s so sad because I want to really enjoy my cosmetic results, but the constant discomfort and the hassle and expense of treatment is really holding me back from that.

6-ish Month Update

I thought I'd put in an update since it's been over a month since my last one. I'm close to being 6 months post-op, and I'm still having problems with dry eyes, lagophthalmos, and loss of sensation. The dry eyes and lagophthalmos are significant problems, but the loss of sensation doesn't bother me much.

For the dry eyes, I currently have 4 punctual plugs, and I'm using Restasis twice per day. For the lagophthalmos, I'm still having to create a "moisture chamber" out of plastic wrap every night when I sleep. I am able to wear my contact lenses, but I have to use rewetting drops a few times a day. For the most part, this keeps my left eye comfortable, but my right eye is drier, and I can almost always feel the contact lens in that eye, which is irritating.

Since my last update, I was prescribed a steroid drop called FML (I know -- hilarious, right?) for my right eye, but that did not seem to help. I had noticed that, even with the punctal plugs, I would taste the FML drops in the back of my mouth shortly after using them, so I thought I had a loose punctal plug. We tried replacing it, but that still didn't make a difference. So, these are the next things the doctors (yes, I have 3 now) to address my problems with dry eye and lagophthalmos:

1. Try a few different types of contacts lenses made for people who struggle with dry eyes. I'm REALLY hoping this will help since I'm currently tolerating my contacts fairly well, but still have some problems with my right eye feeling too dry.
2. If that doesn't work, try elevating the lower lids with a dermal filler such as Restylane or Juvaderm. Even if I do get contacts that work better for me, I might still consider this step to address my problems with lagophthalmos.
3. Try serum drops (made from my own blood). I don't really want to do this because it would prevent me from wearing my contacts most of the time.
4. Consider an additional surgery to elevate lower lids. I'm assuming this would only be done later on as a permanent measure if the dermal fillers seemed to help.

Ups and Downs

I've had a lot of ups and downs since my surgery (probably more downs than ups). Recently, I was up all night fretting about how I might be facing a lifetime of having to use serum drops, Restasis, punctal plugs, and plastic wrap (and/or further surgery). I shed some tears and got up and typed this out the list below around 3:00 AM just to vent some feelings. Take it with a grain of salt -- I know it sounds a bit dramatic (I was crying and hadn't slept), but it's a great example of how I feel sometimes.

"Here is why I'm sad:
• I'm facing a lifetime of constant eye discomfort and even pain at times.
• I'm facing a lifetime of expensive and inconvenient treatments (Restasis, serum drops).
• With these treatments, I may never get to wear contacts again except for an hour at a time.
• Glasses hamper my active lifestyle.
• Glasses are ugly (the whole point of this was to look better, and now I must hide behind glasses).
• I'm facing a lifetime of using ointment and plastic wrap on my eyes at night, which is embarrassing and uncomfortable.
• I fear additional surgery to elevate lower lid might not help my condition or it might even make it worse.
• I fear additional surgery to elevate lower lid might make me look even worse than before the original surgery. I could not bear feeling disfigured.
Oftentimes, I can't sleep, I cry, and I feel distracted at work and at home.
It feels like there is no way out of this nightmare I've created for myself... All because I just wanted to look a little better."

Officially changing from "Not Sure" to "Not Worth It"

Hi All,So, I'm officially changing my review from "Not Sure" to "Not Worth It." I am still dealing with complications (severe dry eye and lagophthalmos), and now I'm not even sure I'm that crazy about my cosmetic result anymore. In terms of the complications, the good news is that I've been experimenting with some new contact lenses (Acuvue Oasys with Hydraclear Plus), and these, combined with 4 punctal plugs and Restasis, seem to finally be making the dry eye symptoms tolerable. I still have to place plastic wrap over my eyes every night when I sleep to keep them moist due to the lagophthalmos. In terms of my cosmetic results, there are several things that are really starting to bother me. 1) There is still quite a bit of extra tissue on my left, upper eyelid, so it still looks somewhat hooded/droopy. 2) There is a really weird hollow spot to the left of my left eye. 3) The lateral canthus (outside corner) of both eyes looks really rounded. 4) I have some lower lid retraction/rounding and there is scleral show where I didn't have it before (where you can see the whites of the eyes below the iris). I'm going to post some pictures here. Please take a look and let me know what you think. I'm hoping these issues are not as bad as I'm making it out to be.

More Ups and Downs

Wow - It's kind of crazy how many ups and downs you can have throughout this process. I'm leaving my review status as "Not Worth It" due to the lifelong complications it has caused. In terms of my cosmetic result, it's definitely not perfect (there are a number of *new* flaws), but overall I DO feel like I look better than I did before. My thanks goes out to everyone who looked at my most recent pictures responded with feedback. Your comments helped pull me out of sadness and back into a much more positive place.

Deep Regrets

I have an acquaintance who very recently had upper and lower blepharoplasty with another surgeon, and she had no complications, and her eyes looked absolutely gorgeous. Her lateral canthus on either side was not distorted like mine, and she had no lower lid retraction. I spoke with her surgeon, and although he also uses the transcutaneous method too, he said he does not extend the incision beyond the lateral canthus like my surgeon did. He indicated that my surgeon probably did this to remove excess skin/wrinkles, but it was done at the cost of distorting the shape of the eye and causing complications. He also indicated that any remaining wrinkles could have been removed with laser treatments instead of extending the incision past the lateral canthus.

I chose my surgeon because she was recommended to me by two different doctors. I didn't speak with any other surgeons because I trusted the other doctors' recommendations. I blame myself for this, and deeply, deeply regret my actions. I am relatively young, and I now must deal with the terrible consequences for the rest of my life:
• Dry eyes: My eyes are always in at least a slight state of irritation, and sometimes they just hurt like Hell. I think back at the times where I didn't even think about my eyes (because they never hurt), and it makes me so sad. I have to have punctal plugs, expensive Restasis drops that burn, and special contacts just to make things tolerable.
• Nocturnal Lagophthalmos: I will probably have to sleep with plastic wrap on my face for the rest of my life. Not only is this embarrassing, but if I go to bed without it, I wake up with *extreme* pain only an hour or so later. I have an overnight flight coming up, and I don't even know what I'm going to do. Whip out the plastic wrap on the plane? What if they don't even let me bring it on the plane because of the sharp cutting edge on the box? These are things I never had to worry about before.
• Less-than-ideal cosmetic results: I am now at the point where I am a little self-conscious about the distortion of my lateral canthus on both sides as well as the scleral show. I feel like it may be obvious to other people that I've had plastic surgery. What's worse is that my surgeon said we should keep an eye on it over the next few years in case it gets worse. Really?! This could get worse?

I knew going in that there would be risks of complications or less-than-ideal cosmetic results. What I didn't realize was that ALL of this would happen (multiple complications and imperfect results). Up until this surgery, I had lived a life free of regrets. I always made smart decisions. But now I will face my regrets every day for the rest of my life.

If you're considering cosmetic surgery (especially lower blepharoplasty), make sure you discuss and explore different methods with several different surgeons. Don't base your choice of surgeon off another doctor's recommendation. Instead, base your decision off a previous patient's recommendation (unfortunately, I didn't know anyone else who had had the procedure done until after I had mine done).

1 yr post-op with complications from upper & lower bleph - Has anyone had successful revision surgery?

It has been one year since I had upper and lower (transcutaneous) blepharoplasty, and I still struggle with both functional and cosmetic issues. Cosmetically, on both eyes, I have lower lid retraction and scleral show (lower lids pulled down to expose more white of the eye), a rounded lateral canthus (rounded outer corners), and some asymmetry of the upper lids. Worse yet, functionally, I struggle with dry eye syndrome, and I'm unable to keep my eyes completely closed at night when I sleep. I have considered revision surgery, but the fear of making things worse has prevented me from really pursuing it. If there is anyone out there who has experienced similar problems and had successful revision surgery to correct them, I would LOVE to hear from you! Please, reach out to me!

More Pictures: Gradual Rouding of Lateral Canthus Post-op

It's been 20 months since I had my surgery, so I figured I'd post another update. I still rely on Restasis, punctual plugs, and plastic wrap in order to feel mostly comfortable most of the time.

I wanted to post some pictures of the gradual rounding of the lateral canthus that has occurred in both of my eyes. As you can see from my pictures, my surgical results looked okay in the first few months, but over time, the corners have "stretched" to become rounder and rounder. Aside from contributing to the overall dry eye problem, I think it looks pretty darn weird. I'm hoping that it has finally stabilized and won't get any worse, but who knows? :-(

2 Year Update

So, it's officially been two years since I had upper and lower blepharoplasty, and I still deeply regret my decision to have it done. I won't rehash all the consequences -- just know that nothing has improved since my last few posts and things will probably even get worse with time.

One thing of interest is that I found an article that very clearly articulates everything that has happened to me in medical terms and even mentions some techniques for correcting it [article here: http://asj.oxfordjournals.org/content/33/4/497.figures-only] Unfortunately, these techniques (drill hole procedures) to correct the problem seem extremely invasive, and I'm not willing to try them. I read a review from another person on here who'd had a drill hole procedure done, and it made things much worse for her. Still, I'm thinking of asking my surgeon to look at the article just so I can more clearly express what I think has happened to me.
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