Thank you for your question.
You submitted several photos and you expressed in your question that you had lower eyelid
surgery done approximately 3 weeks prior.
And that you are concerned in particular with the appearance and sensation of the left lower
eyelid where you feel like it looks a little bit like pulled down and you’re seeing a
little bit more of the inside of the eyelid with the left eye.
And you’re asking about whether or not this appearance is normal.
Well, I can certainly share with you my understanding of your situation with just the photos alone
with the absence of a physical exam.
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.
I am very well known for revision eyelid surgery and patients come to our practice from all
over the world for complications of eyelid surgery such as lower eyelid retraction and
ectropion and things like that or problems commonly caused occurring after lower eyelid
surgery.
So to begin with, this appearance that you have is actually fairly common after lower
eyelid surgery.
Not necessarily a good thing but it is an approach that a lot of plastic surgeons and
facial plastic surgeons prefer to do which is an external approach to the lower eyelids.
This is called a transcutaneous blepharoplasty.
And generally speaking, in my experience of seeing patients like yourself, the surgeon
will approach the lower eyelid fat pockets and address everything by making an incision
underneath the eyelashes and getting into the fat pockets and then removing some skin
with the desire to improve tension in the skin of the eyelid.
It is generally my experience that patients will end up with their eyelids being rounded
and pulled downward.
And in some situations, the eyelids will actually evert and the term is ectropion.
Now the reason why it’s an interesting question whether or not it’s normal, well it depends
a lot on the philosophy of the doctor who is performing the surgery.
In my practice, majority of my procedures I do from the inside of the eyelid.
It’s called a transconjunctival blepharoplasty.
And it is essentially, with my understanding of the approach and my preferred approach
to helping people with under eye bags by working from behind the eyelid and preserving the
skin and muscle in the front which then begs the question what about the fine lines and
wrinkles under the eyes?
Well, what we generally do is instead of trying to remove skin, we actually use lasers and
platelet-rich plasma (PRP) to improve the skin quality.
And this combination for me has been very effective.
And since we do so many of these procedures, certainly with over 20 years of experience,
I can tell you that the overwhelming majority of patients maintain the position of their
eyelid and the shape of their eyes.
Therefore, for me, it’s the preferred procedure.
Now that being said, when patients like yourself have come to my practice very distressed about
their appearance where you’re seeing too much of the white of the eye and that’s
referred to as lower eyelid retraction.
And if the eyelid is everted, it’s called ectropion and for you, it’s not exactly
everted but there’s a gap.
What I tell those patients is that unless there’s immediate issue related to eye health
or integrity, where the ability to close the eye and protect the eye is compromised, you
generally have to wait and allow for some return of muscle function and some degree
of elastic stretching of the tissue in order to see if it returns to its better position.
Generally speaking, when situations like this, your eyelids will likely at least not evert
away from your eyes with time.
You may want to look at your before pictures and compare and see how much of the white
of your eyes were showing before surgery and certainly we don’t have the benefit of seeing
those photos with your question and seeing what the eyelid position looks after surgery.
It’s important that you have this discussion with your doctor.
Your doctor and you made this decision to approach the surgery in this particular way
and I’m sure your doctor explained to you what to anticipate.
And of course, it’s important to maintain the follow-ups.
Now, it is again necessary to at least understand what is happening and a lot of times, a doctor
will recommend in a situation like this basically one intervention and that is upward massage
where you push the eyelid upward and try to get some stretch so that the eyelid can actually
move upward and the scar tissue or healing tissue doesn’t pull the eyelid further down.
And that’s probably the one therapeutic measure that is essentially universally accepted
as something you should do at this stage of your healing process.
In the absence of feeling the eyelid and being able to see if it’s tethered or stuck, I
think that might be worthwhile doing again after contacting your doctor and asking about
that.
So I hope that was helpful, I wish you the best of luck and thank you for your question.