The appearance of our eyes is a symptom of well-being. They are the most distinctive feature of any person’s face and are the first feature to attract another person’s attention. Therefore, any irregularities will be noticed by others. It is crucial for any type of eyelid surgery to be natural and to avoid an ‘operated on’ look, but it is equally important not to damage the function of the eyelids.
Very often, eyelid surgery performed by non-expert surgeons alters the natural appearance and/or causes damage to the eyelids with significant visual sequelae (not being able to close your eyes, dry eyes, blurred vision, etc.).
One of the most frequent reasons for consultation in this area is the retraction of the lower eyelid. It can be produced by two mechanisms. First, by excessive scarring of the inner layers of the eyelid (orbital septum and orbicularis muscle) when they have been mishandled. The tissue reacts violently to this aggression, contracting excessively and causing the lower eyelid to descend. Secondly, excessive skin and fat removal in the lower eyelid also results in lower eyelid descent, sometimes even with ectropion. In both cases, a “round eye” appearance is produced and causes eye discomfort in the form of chronic irritation, dryness of the eye and corneal problems.
To recover the almond shape of the eye, a simple canthopexy is not enough in these cases to raise the eyelid. In these complicated cases, canthopexy does not succeed in elevating the eyelid since the forces that pull the eyelid downwards are much greater, and more complex techniques are needed to solve them.
On the one hand, if the patient is seen in an early post-operative period (first weeks), it may be necessary to treat the eyelid with anti-fibrotics to slow down the healing process and/or with hyaluronic acid, before deciding to perform any type of intervention.
In those cases where the inflammation has subsided and there is a retraction of the lower eyelid, we perform a transconjunctival cheek lift technique (midface lift without scar or midfacial lift) that manages to raise the eyelid without having to resort to unsightly skin grafts. By raising the cheek we manage to give extra support to that damaged eyelid, providing malar fat and skin. It may also be necessary to use a graft of your own ear cartilage in the most severe cases. These are implanted through the conjunctiva and are invisible.
Other causes of unsatisfactory results after blepharoplastyare upper eyelid retraction due to excessive removal of skin and muscle, excessive or insufficient removal of fat pads, asymmetries, or failure to treat a palpebral ptosis (drooping eyelid) at the time of an upper blepharoplasty.
Blepharoplasty corrective surgery can solve most of these problems, but one must be very cautious when indicating a new surgery on a previously operated patient. A good doctor-patient understanding and reasonable expectations on the part of the patient are very important. In non-urgent cases (without eye involvement) it may be preferable to wait 6 months before performing a new surgery.