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What can be done for lower blepharoplasty surgery complications nine months later?

Q:

I had lower blepharoplasty surgery on Jan 12, 2011.  The external incision technique was used.  I cannot close my eyes all the way.  They are dry and red in the morning. The skin is also very irregular and you can see it bunching as I try to close my eyes.  What can be done to correct this?

A:

Seven months after surgery, you should be fully recovered. You might have developed an Ectropin of the lower eyelid following your lower lid blepharoplasty. You may want to use a lubricant such as Lacrilube at night when you go to bed and irrigate your eyes out with an eye rinse until you can get the situation evaluated to prevent complications from dry eyes. Both products are Over the Counter.

Next, may I suggest you seek out one of the many members of the ASAPS that specializes in occuplastic surgery in your area.&n They should be able to address your concerns and suggest methods to correct your issues. I would not delay in this matter.

Best,

Gary R. Culbertson, MD, FACS

A:

Unfortunately you are suffering from some significant bad problems as a result of your surgery. It is difficult to be specific about what is the cause of your problems without reviewing your operation report and examining you. Whatever is causing your problems needs to be addressed and addressed quickly. It sounds like you are suffering from an ectropion, pulling down of your lower lids, from either an over resection of the skin or a scarring problem. Regardless, you need to see a qualified Board Certified Plastic Surgeon with experience that can diagnosis your problem and treat it. The good news is that with a qualified surgeon you should be able to have your problem corrected. Unfortunately it will almost assuredly require additional surgery.

C.W. Lentz, MD

A:

Inability to close the eyes after lower blepharoplasty is a significant problem. The redness and dryness you are experiencing is the result of this. You need to see a surgeon who specializes in these problems. The problem is either too little skin or scar in the deeper structures. Either way, the correction is not easy but essential. Until you get in to see someone, the products suggested by Dr. Culbertson are good. Others are Refresh, which comes as a thicker drop for night and a thin one for day, and Systane for day use. They are also OTC. At this point you will not improve without doing something. Make an appointment soon.

R.T. Buchanan, MD

A:

Seven months after lower lid blepharoplasty and you are still having problems with closing your eyes and symptoms of eye irritation suggests that you possibly have ectropion.

Use artificial tears during the day, and Lacrilube at night. Call your plastic surgeon to immediately have this evaluated, and set a plan for repair. This is a known risk of lower lid blepharoplasty, and is repairable, but requires expertise.

S.F. Shureih, MD

A:

Lower Eyelid Complications:

If one has problems after lower eyelid surgery then one should wait at least 6 months. If one continues to have problems then one can reassess whether secondary surgery, lower eyelid support, or canthopexy is needed. This needs to be done by a Board Certified Plastic Surgeon or Oculoplastic Surgeon who has expertise in secondary eyelid surgery.

R.J. Rohrich, MD

A:

Lower lid hollowness following an overly aggressive lower blepharoplasty can be improved by a surgeon skilled and experienced with fat grafting. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the take of the initial fat grafting surgery.

Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.

M.M. Law, MD

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