my eyes can't close fully after eyelid surgery what can I do cosmetic eyelid
surgery is a delicate and precise procedure where the difference between
an outstanding result and a complication such as eyelids unable to close properly
can be measured in millimeters eyelid surgery ranks typically at about number
three in the top five cosmetic surgery procedures year after year this means in
general plastic surgeons as well as non surgeons offer cosmetic eyelid surgery
however when it comes to revising complications after cosmetic eyelid
surgery such as the eyes not properly closing the specialist of choice is a
Fellowship-trained oculoplastic surgeon I'll explain how I approach
complications from eyelid surgery for people who come to me from around the
world in my practice I'm Dr. Amiya Prasad I'm a board-certified cosmetic
surgeon and fellowship trained oculofacial plastic and reconstructive
surgeon I've been in practice in Manhattan and Long Island for over 20
years as a cosmetic oculofacial plastic surgeon I regularly perform primary
cosmetic upper and lower eyelid surgery as well as revision and reconstructive
surgery for the eyelids an important complication associated with upper
eyelid surgery occurs due to skin shortage after surgery in cosmetic upper
eyelid surgery redundant or excess eyelid skin is carefully measured and
excised to address eyelid hooding additionally fat can be sculpted to
improve the shape and appearance of the eyes when too much eyelid skin is
removed during surgery this can result in having a serious
effect on eye health with the eyelid not being able to properly close another
cause for eyelid skin shortage occurs when eyelid skin is removed without
addressing eyelid ptosis eyelid ptosis is a condition where the upper eyelid is
lower than it should be which makes you look and often feel tired
this drooping of the eyelid is associated with the function of a muscle
which lifts the eyelid called the levator muscle eyelid ptosis surgery
requires extensive knowledge and experience that is not part of any other
surgical training other than oculoplastic surgery in order to train
as an oculoplastic surgeon you need to first train in ophthalmology or eye
surgery I find that general plastic surgeons often don't recognize ptosis
and remove upper eyelid skin for cosmetic enhancement even if there is
very little skin to remove in these cases eyelid skin is removed but the
island still droops since the ptosis wasn't treated there can also be a
shortage of eyelid skin at the same time with lower eyelid surgery
a skin shortage can also be an issue when lower eyelid skin is excised
doctors often remove lower eyelid skin thinking redundant skin is causing
wrinkles this is often done during surgery to address the under-eye bags
called lower eyelid blepharoplasty since facial aging is significantly caused by
bone loss particularly around the eyes and cheeks the skin can appear to sag
in addition age sun exposure and other health related issues affect skin
quality which results in skin wrinkling skin quality can be treated without
removing skin the lower eyelid position depends on a delicate balance of the
skin muscle and tendons when surgeries such as transcutaneous
blepharoplasty is performed by making an below the eyelashes and having skin
removed this delicate balance is at risk of being compromised
a skin shortage of the lower eyelid can result in conditions such as lower
eyelid retraction and lower eyelid ectropion I routinely perform lower
eyelid surgery by addressing the puffy under eye bags from the inside of the
eyelids using a technique called transconjunctival blepharoplasty which
preserves this delicate balance at the same time I treat wrinkles with
different types of lasers and radiofrequency technology combined with
regenerative medicine technology such as PRP or platelet-rich plasma if there is
a fold of skin that is overlapping I'll perform a limited skin pinch type of
excision coming from a background in ophthalmology I always emphasize to my
patients the importance of optimal eyelid function for proper eye health
for example the simple action of normal blinking is critical because the eyelids
function like windshield wipers to distribute your tears evenly over the
front surface of your eyes proper lubrication of the cornea which is the
clear part of the eye you see through is necessary for optimal vision people with
an eyelid skin shortage complain of having irritation such as a foreign body
sensation and dry eyes because the eyelids can't function properly to
lubricate the surface of the eye patients with upper or lower eyelid skin
shortage report that sleep is difficult because the eyes don't fully close
leaving a gap resulting in irritation mucous production and blurred vision no
surgeon is immune to dealing with complications or unanticipated outcomes
however the optimal management of complications is critical
much of eyelid surgery issues such as skin shortage retraction or undiagnosed
ptosis can be managed through the basic principle of restoring anatomy for
optimal appearance and function I find that a lot of patients who come in for
revision eyelid surgery underwent several attempts by the original surgeon
to improve the patient's condition with ineffective surgical procedures which
often makes things worse when evaluating a patient with difficulty with our
closure I look first at the immediate management of the eye itself to ensure
preservation of vision and eye function I look at specific anatomic deficiencies
such as skin shortage or internal tissue scarring I determine if it makes sense
to wait and allow for tissue relaxation to potentially improve the patient's eye
closure without surgical intervention if there is a significant upper eyelid skin
shortage an option is to do a skin graft in the lower eyelids the balance of
anatomic components were compromised often requires procedures such as skin
graft lower eyelid support graft and the repair of a canthal tendon or the
attendant supporting the eyelid in cases where eyelid ptosis was not addressed at
the time of surgery I approach this problem through ptosis surgery
procedures such as levator muscle advancement or from behind the eyelid
with a technique called conjunctiva Muellerectomy I typically perform a
revision eyelid surgery in my private office surgical facilities I also
performed a surgery with local anesthesia and LITE IV sedation people
coming for revision eyelid surgery are often quite relieved that they aren't
going through general anesthesia again although complications can occur with
any procedure I exposure and the potential for compromising vision makes
the outcomes of primary eyelid surgery and revision eyelid surgery more than
just about appearance restoration of function appearance and character to
your eyes is possible in most situations should you experience a problem after
undergoing eyelid surgery I hope you found this information helpful thank you
for your question