Thank you for your question.
You submitted your question with two photos.
And you stated that you are about a month out after upper and lower eyelid surgery.
And you’re concerned because you feel that your creases are too high and that your left
eye has an ectropion.
And you are insisting on revision and you’re asking if it’s appropriate or feasible at
one month.
Well, I can certainly share with you how I advise patients who come to me from all over
the world for revision eyelid surgery.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Helping patients who have had complications with eyelid surgery done elsewhere has been
a very big part of my practice.
Essentially, I can give you some of the guidelines that I tell my patients who consult with me
as early as one month after surgery.
So to begin with, let’s start with what is essentially a central idea as to what to
do and when to do something to help with the appearance versus functionality.
So there are times when patients have come to me and they have had severe ectropion where
the eyelid was significantly everted and they needed surgery sooner rather than later because
of potential compromise in eye function.
So essentially, the urgency of revision surgery is dependent a lot on the quality of the integrity
of the eye itself.
You know, the eyelids, besides appearance, it’s important to understand that eyelids
that look good function well.
And so if there’s an ectropion or retraction, it doesn't mean that it always has to be addressed
immediately.
But if it’s more severe where the function is compromised, then surgery is done.
Generally speaking, if it’s mild or minimal, you can treat the surface of the eye conservatively.
You can use artificial tears and you can do other things to help just buy some time to
allow some of the healing process to stabilize.
There is always an important variable which is the relative stability of the eye appearance
that is important to me when I do revision eyelid surgery.
When I do any kind of revision, let’s use the lower eyelids for example, if someone’s
eyelid is only done like let’s say a month ago like yours, then there is still opportunity
for healing such that if the eyelids are a little bit low, you can massage.
You can do other more conservative things to help encourage healing and you might get
a millimeter or so or more of vertical height restored.
And after 3-6 months, you might be in a better situation and may or may not need revision
surgery.
And if you do need revision surgery, at least we’re not working with what I refer to as
a moving target.
When there’s a lot of variability, when there is still swelling, when there is scar
tissue, it sometimes is challenging.
Now a lot of times patients come to me after they have had multiple revision surgeries.
And in those situations, I actually have to help rehabilitate the tissue.
And so I’ll do things such as use platelet-rich plasma (PRP), Acellular matrix to help rehabilitate
the tissue before doing surgery.
But specific to your situation, I think first of all, it’s very important to not just
abandon your doctor.
If you chose your doctor based on a trust that was developed after consultation and
establishing an understanding and confidence in their experience and ability to do your
surgery, it is still in your best interest to first work with the doctor who performed
the procedure.
That doctor knows your anatomy, understands what was done at the time of the surgery and
may be be able to help you get through this healing process and get you closer to where
you want to be.
A lot of times, it is often the desire for every patient and every doctor is to avoid
any complication in every patient or in every situation.
But the reality of dealing with the human being is that complications do occur.
Infections, scarring, wound healing that wasn't anticipated happens to anyone who performs
or any patient and physician who performs surgery will recognize that these things do
happen.
So I think it’s still important that you not just abandon ship but at least work with
your doctor.
As long as your eye health is not compromised, you have some time before you can address
the aesthetic issues and the functional issues.
That being said, if for any reason you feel that your doctor is not attending to your
concerns, there is always an opportunity to get a second opinion from a specialist, from
someone who is an expert at eyelid surgery just to get an opinion.
But I would say that a lot of times, patients have come to me for this type of opinion,
I essentially document with photos and examination of what they look like at that point and then
I follow them and I see them after 3 months, 6 months and beyond and watch how they do
before considering doing any type of revision surgery.
So the principles again are about maintaining and protecting the eye in terms of ocular
health, making sure that lubrication and there is no issue with vision compromise and further
ensuring proper wound healing then stability before undergoing any revision procedure.
So I hope that was helpful, I wish you the best of luck and thank you for your question.