Female Speaker: Asymmetry after blepharoplasty/double eyelid surgery; one eye droops, vision blurred. Is it normal? The surgery was on April 8, 2014. The plastic surgeon tightened the muscles involved in opening/closing of upper eyelids in addition to blepharoplasty and forming Asian double eyelids, inward folding type. Ten days after the surgery, the two eyes are uneven. My right eye seems overdone, lashes are pushed way up and there seems ectropion. My weaker left eye does not close all the way, making it very dry. The surgeon said all will be fine in time. Should I have my right eye corrected ASAP?

Dr. Amiya Prasad: Thank you for your question. You submitted a question about asymmetry after Asian eyelid surgery, as well as concerns about issues related to difficulty with closure and possible ectropion where the inside of the eyelid is turning out and you want to know if you would need to have a revision as soon as possible.

Well, as a cosmetic oculofacial plastic surgeon who specializes in revision surgery for cosmetic eyelid surgery, I can certainly give you some insight as to what kind of timing is appropriate if a revision is necessary.

We have patients who come to us from all over the world, who have had difficulty with eye closure from too much skin from the upper eyelids being removed. More commonly we see a lot of patients who have had lower eyelids pulled down or eyelid retraction or ectropion where it's everted and turned away, resulting in severe exposure irritation and ultimately aesthetic revision for people who just don't like the way their eyelids look because they don't feel like they look like themselves. When someone gets rounding of the lower eyelids and they're used to having an almond shape, they can be very, very distressed about this and this is something we do a lot of work with.

Now, that being said, it is now ten days since your surgery and you are having these symptoms. Now, predicting how much they'll resolve is dependent on factors such as some degree of swelling, the nerves that innervate or feed these muscles working and coming back, as well as the absolute amount of skin that's available for the eyelid to be in the proper position. I think it's reasonable in a situation like yours, as long as there is no significant eye exposure. The core issue is always in terms of urgency, is the health and integrity of the eye itself, in danger, even with conservative management. When I say conservative management, I'm usually talking about topical lubrication.

In other words, if someone has an issue that most likely will need revision, if they can keep the eye moist with artificial tears, ointment at night, wearing of goggles or keeping a humidifier in the room, whatever it takes to keep that eye moist, so that we can time the surgery where the tissue is less swollen, is very beneficial. Swelling, as I describe to my patients, is essentially like working on a moving target when you're doing surgery and it distorts the anatomy and makes it challenging to be able to have predictable and consistent results. At ten days, as long as your doctor is advising you about how to keep your eyes well lubricated and managing you in terms of the procedure itself, then you do have some time.

We make these decisions based on how much we think that there will be scar tissue that will hinder any type of revision surgery. A lot of times, it is advisable before a lot of scar tissue forms to do the procedure to revise the surgery and that can be within the first couple of months. We're talking about more by months, rather than days. If there is a situation where it is what we call plus/minus or just slight, then we may wait six months to a year to allow for full healing and softening of scar tissue and settling out. As long as things don't move in the wrong direction or an undesirable direction, you do have some time.

To summarize, I want to stress, do everything necessary to protect the integrity and quality of the health of the eyes. In addition, work with your doctor as far as management. Sometimes, just massaging when the lower eyelid is everted slightly, people will sometimes successfully just massage the eyelid up and get enough of an improvement. If there is a real skin shortage, then that doesn't work, but these conservative measures are appropriate early in the healing phase. Continue working with your doctor and hopefully things will resolve as time goes on.

I wish the best of luck. I hope that that was helpful. Thank you for your question.

Top Tips For Healing After Asian Eyelid Surgery

Dr. Amiya Prasad breaks down: -Temporary issues after Asian eyelid surgery -How massage can help ectropion -If and when you should consider a revision surgery