What is corrective surgery?
The appearance of our eyes is a sign of well-being. They are the most distinctive feature of any person’s face and the first thing that catches another person’s attention. Therefore, any irregularity will be noticed by others. It is crucial for any type of eyelid surgery to maintain a natural appearance and avoid a “doctored” look, but it is equally important not to impair eyelid function.
What are eyelid surgery patients like?
Too often, eyelid surgery performed by non-expert surgeons alters the natural appearance and/or causes damage to the eyelids with significant visual consequences (inability to close the eyes, dry eyes, blurred vision, etc.).
One of the most common reasons for consultation in this area is lower eyelid retraction . This can occur due to two mechanisms. First , excessive scarring of the inner layers of the eyelid (orbital septum and orbicularis oculi muscle) when they have been poorly manipulated. The tissue reacts violently to this aggression, contracting excessively and causing the lower eyelid to droop. Second , excessive removal of skin and fat from the lower eyelid also results in drooping of the lower eyelid, sometimes even with ectropion. In both cases, a “round eye” appearance is produced and causes ocular discomfort in the form of chronic irritation, dry eyes, and corneal problems.
To restore the almond shape of the eye, a simple canthopexy to elevate the eyelid is not sufficient in these cases. In these complicated cases, canthopexy fails to elevate the eyelid because the forces pulling the eyelid downward are much greater, and more complex techniques are required to resolve them.
On the one hand, if we see the patient in an early post-operative period (first weeks), it may be necessary to treat the eyelid with anti-fibrotics to stop the scarring process and/or with hyaluronic acid , before deciding to perform any type of intervention.
In cases where the swelling has subsided and the lower eyelid is retracted, we perform a transconjunctival cheek lift (scarless midface lift) that elevates the eyelid without resorting to unsightly skin grafts. By elevating the cheek, we provide extra support to the damaged eyelid by adding malar fat and skin. In more severe cases, a cartilage graft from the patient’s own ear may also be necessary. These are implanted through the conjunctiva and are invisible.
Other causes of unsatisfactory results after blepharoplasty include upper eyelid retraction due to excessive skin and muscle removal, excessive or insufficient removal of fat pads, asymmetries, or failure to treat eyelid ptosis (drooping eyelid) at the time of performing upper blepharoplasty.
Corrective blepharoplasty surgery can resolve most of these problems, but caution must be exercised when recommending a repeat surgery for a patient who has previously had surgery. A good understanding between the doctor and the patient, as well as reasonable expectations, are very important. In non-urgent cases (without ocular involvement), it may be preferable to wait six months before performing a repeat surgery.
