First take a deep breath. Things happen after eyelid surgery. Many things fix themselves with a little time. Before surgery, your surgeon went through a lengthy list of things that might happen with surgery. Of course it is human nature to think that none of that will happen to you. In some cases I think that the surgeon sends a subliminal message that even though all this stuff is in the consent, it is a mere formality. Having an issue after surgery is an unwelcome shock. If you trust your surgeon, that confidence should help get you through the rough patches after surgery.
There can be a number of reasons for why the lower eyelid sags after surgery. In some cases swelling can push the lower eyelid away from the eye. This can occur in conjunction with a process called chemosis. Chemosis is the medical term for swelling of the white of the eye or the conjunctiva. Just as the eyelid will swell after surgery, the conjunctiva can swell. When it is swollen, the conjunctiva has been described to look like “jelly.” The best treatment for this is ocular lubrication and time. This often resolves with tincture of time.
Another cause of lower eyelid sagging is preexisting laxity of the lower eyelid. Swelling after surgery causes the laxity to be exaggerated resulting in the unsatisfactory position of the eyelid. In many cases again time is the best treatment.
When the surgeon cuts the skin of the lower eyelid to remove “extra lower eyelid skin,” malposition of the lower eyelid can be more serious. Under these circumstances the lower eyelid can be short of skin or the muscle that helps hold the lower eyelid against the eye can actually be damaged by the surgery. Rather than allowing this to heal, surgeons often feel the need to provide an early fix. That early fix can help resolve the issue or make it worse.
Generally, due to mechanical issues, some of the simple treatments can actually be helpful. These include steroid injection, mechanical finger winking, and when appropriate a pull up suture placed to support the eyelid corner for a few weeks. When these measures fail, it is best to let the eyelid heal before attempting revisional surgery. So often Dr. Steinsapir is called in to fix an eyelid where the original surgeon has made several well meaning attempts to “tuck up” the eyelid early after the original surgery with each procedure making the situation worse.
What will your eyelid need? It often depends on precisely what factors are contributing to the circumstance. If your surgeon was not a fellowship trained oculoplastic surgeon, it is often helpful to see someone who is. The additional training and experience may be precisely what is needed to address the situation.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a