Thank you for your question.
You state in your question with some photos submitted that you are having lower eyelid
surgery and you describe that the left lower eyelid is not touching the eye and you want
to know is this ectropion or is this retraction and what to expect before moving forward.
Well, certainly I can give you some guidance with this question.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years.
Cosmetic oculofacial plastic surgery is a major focus in my practice.
And in fact, revision of cosmetic eyelid surgery is a very big part for patients who come to
us from all over the world for problems similar to you such as eyelid retraction which is
extremely common.
Before going into the details of your questions, I have a lot of familiarity with situations
like yours and I can certainly give you some guidance with the absence of a physical examination.
So to begin with, the photos you submitted in the left eye, it is clear that the margin
of the eyelid is away slightly from the eyeball and so that technically is referred to as
ectropion.
Certainly, there are many degrees ectropion and this is considered a very minimal ectropion.
As far as the concern of definition of eyelid retraction, I think it is important to just
compare the two eyes as well as your eyelid position was before surgery.
Now as to what causes this, I can describe to you what I perceived from experience treating
other patients like yourself.
Typically, when a doctor performs lower eyelid surgery from the outside, an incision is made
beneath the eyelashes and fat pockets are reduced and then any excess skin is trimmed
and stitches is placed to close the eyelid.
This approach is called transcutaneous approach.
It means incisions are on the outside.
Often this results in two challenges: one is there could be a slight skin shortage or
a significant one and in addition there is a muscle called orbicularis oculi muscle that
tends to become a little bit dysfunctional.
In other words, it is a muscle that is necessary to keep the eyelid against the eyeball and
temporarily, there is a combination of swelling and something called neuropraxia where there
is a temporary reduction of the muscle tone from the nerve fibers that go into the muscle
that can also be contributing to this situation.
Now, I have many patients who have worst situations who come to me this early after surgery because
their eyes, wherein potential danger in terms of vision and I actually operate on them sooner
than later.
In your situation I think you have some time.
Speak to your doctor about this and in general, in my practice, when people yourself come
to me, I advise first lubricating drops to keep the eyes moist.
It is very important to maintain the health and function of the eye.
In addition, it is routine for me to recommend massage and this is something you need to
discuss with your doctor.
This is not something I would recommend to you to just do without consulting your doctor
first.
The point of the massage is to bring the eye into the proper position and it helps release
scar formation and allows the eyelid to gently be pushed into the proper position.
It has been my experience, and when a slight one like this, then it usually gets better
on its own.
And as long as you are happy with the eyelid position and the appearance, you are in good
shape.
So, I think that without going into the semantics of what defines ectropion, what defines retraction,
you need to look at the big picture and see do you like the way how the other eye looks
and what can you do to make the left eye look more like the right eye.
And I think in this time frame, two weeks out, you probably have good odds of your eyelid
moving into the proper position so that you can get a more symmetric and functional outcome.
So talk to your doctor, discuss the option of lubrication and massage and see how things
transpire over time.
If things get worse or things continue to move the right direction, these are things
that clinically may help us make decisions and strategies appropriately but I think the
odds are in your favor based on the photos along with this very slight amount of ectropion.
I’ve seen situations much worse than this and it did eventually move the eyelid back
into its proper position.
So I hope that was helpful, I wish you the best of luck and thank you for your question!