Thank you for your question!
You submitted a photo and you described in your question that you underwent eye bag surgery
about a month ago and that you are dealing with a problem with the eyelid being everted
or turning away.
And you’re asking about revision surgery, about timing and that your doctor explained
that it would get better so certainly it’s understandable why you’re distressed.
Just to give you a little bit of my background, I’m a board certified cosmetic surgeon and
fellowship trained oculofacial plastic and reconstructive surgeon.
The oculoplastic surgery background means that I first trained in eye surgery before
training in cosmetic and reconstructive surgery of the eyes which makes me a super specialist
and for the past 20 years, my focus in my practice has been cosmetic and I treat people
from around the world for conditions that look like yours.
So I think that I can give you some guidance as to my thoughts of what you can anticipate
and what options you may want to pursue.
To begin with, the procedure that you had undergone was called a transcutaneous blepharoplasty
which means that your doctor went through the skin through an incision underneath the
eyelashes to address the fat pockets and then to help address maybe some wrinkles or excess
skin, took away skin.
Now that resulted in the relative skin shortage which caused this eversion called ectropion.
Now that means is that there is technically a relative skin shortage and it’s affecting
both of your eyes.
This is a common complaint in a lot of patients who have this external approach but in addition
to that, very often, there’s also a loss of muscular tone that is usually temporary
that could contribute partially to this degree of eversion.
What that means is that, as time goes on, it usually does get a little bit better but
my main concern always is about the health of the eyes.
When the eyelid is everted, the tear film that lubricates the eyes can be compromised.
The internal part of the eyelid which is very delicate and is meant to go against the eyeball
is now exposed to the external environment.
So management by an eye doctor, an ophthalmologist or through your doctor who performed the surgery
is important for proper lubrication and observation to avoid infection.
In terms of timing of surgery, this gets a little bit challenging.
When people come to me with similar conditions, as long as there’s no urgent need to intervene
and there have been cases where that’s the situation where someone’s eyelid was so
pulled down and retracted and their eyes were constantly watering and they were developing
compromise of the cornea including abrasions and ulcerations, I had to move faster.
Or their eyelids were not aligned and I had to revise the surgery sooner rather than later.
But when there is the luxury of some time, it is better to wait to allow for resolution
of swelling.
Now I feel that there’s still a sweet spot when there isn’t too much scar tissue that
I like to go in and do something to help that patient.
The challenge for you is also about the shape of the lower eyelid beyond getting the eyelid
back to position.
It’s not uncommon for a situation like yours to result in the rounding of the lower eyelid.
Now although that may be an acceptable aesthetic appearance, for a lot of patients, it’s
also a challenge because that rounding affects the function of the lower eyelid.
And many times, people feel like they’ve lost the character of their eyes when they
see their eyelids rounded like that.
So there may need to be more than one procedure and there may need to be more than one time
to do those procedures.
So understanding that, I think that if you feel that your doctor and your doctor is guiding
you and is monitoring your situation that you still have some room to wait.
And if there is any issue about the health of your eyes, then seeing an ophthalmologist
is very important.
So understand that this type of situation can be managed, can be improved but it just
seems that at the one month point, with the appearance of your eyes where they are, that
you will need revision surgery.
The question is what kind of revision surgery.
Just to give you an example, when you think of lower eyelid structure, there are three
key elements: the tendon that holds the eyelid, the support structures in the inside and the
skin on the outside.
All of that can be affected by cosmetic surgery but when we have to do revision surgery, you
have to address all of those elements.
Sometimes you can do more or less of one but those elements of aspects of lower eyelid
position need to addressed to get an optimal results.
A lot of times a lot of patients come to us after multiple operations where the doctor
kept on pulling the skin, pulling and pulling, trying to treat it like a facelift and the
eyelid kept on rolling down and down and kept on become worse and worse.
So understand that there are some critical anatomic elements to get not only a good-looking
lower eyelid but a good functioning lower eyelid is something that hopefully you and
your doctor can communicate about so that you get the right procedure and get the best
result possible.
So I hope that was helpful, I wish you the best of luck and thank you for your question!