my eyes can't close fully after eyelid
surgery what can I do cosmetic eyelid
surgery is a delicate and precise
procedure where the difference between
an outstanding result and a complication
such as eyelids unable to close properly
can be measured in millimeters eyelid
surgery ranks typically at about number
three in the top five cosmetic surgery
procedures year after year this means in
general plastic surgeons as well as non
surgeons offer cosmetic eyelid surgery
however when it comes to revising
complications after cosmetic eyelid
surgery such as the eyes not properly
closing the specialist of choice is a
Fellowship-trained oculoplastic surgeon
I'll explain how I approach
complications from eyelid surgery for
people who come to me from around the
world in my practice I'm Dr. Amiya
Prasad I'm a board-certified cosmetic
surgeon and fellowship trained
oculofacial plastic and reconstructive
surgeon I've been in practice in
Manhattan and Long Island for over 20
years as a cosmetic oculofacial plastic
surgeon I regularly perform primary
cosmetic upper and lower eyelid surgery
as well as revision and reconstructive
surgery for the eyelids an important
complication associated with upper
eyelid surgery occurs due to skin
shortage after surgery in cosmetic upper
eyelid surgery redundant or excess
eyelid skin is carefully measured and
excised to address eyelid hooding
additionally fat can be sculpted to
improve the shape and appearance of the
eyes when too much eyelid skin is
removed during surgery this can result
in having a serious
effect on eye health with the eyelid not
being able to properly close another
cause for eyelid skin shortage occurs
when eyelid skin is removed without
addressing eyelid ptosis eyelid ptosis
is a condition where the upper eyelid is
lower than it should be which makes you
look and often feel tired
this drooping of the eyelid is
associated with the function of a muscle
which lifts the eyelid called the
levator muscle eyelid ptosis surgery
requires extensive knowledge and
experience that is not part of any other
surgical training other than
oculoplastic surgery in order to train
as an oculoplastic surgeon you need to
first train in ophthalmology or eye
surgery I find that general plastic
surgeons often don't recognize ptosis
and remove upper eyelid skin for
cosmetic enhancement even if there is
very little skin to remove in these
cases eyelid skin is removed but the
island still droops since the ptosis
wasn't treated there can also be a
shortage of eyelid skin at the same time
with lower eyelid surgery
a skin shortage can also be an issue
when lower eyelid skin is excised
doctors often remove lower eyelid skin
thinking redundant skin is causing
wrinkles this is often done during
surgery to address the under-eye bags
called lower eyelid blepharoplasty since
facial aging is significantly caused by
bone loss particularly around the eyes
and cheeks the skin can appear to sag
in addition age sun exposure and other
health related issues affect skin
quality which results in skin wrinkling
skin quality can be treated without
removing skin the lower eyelid position
depends on a delicate balance of the
skin muscle and tendons
when surgeries such as transcutaneous
blepharoplasty is performed by making an
below the eyelashes and having skin
removed this delicate balance is at risk
of being compromised
a skin shortage of the lower eyelid can
result in conditions such as lower
eyelid retraction and lower eyelid
ectropion I routinely perform lower
eyelid surgery by addressing the puffy
under eye bags from the inside of the
eyelids using a technique called
transconjunctival blepharoplasty which
preserves this delicate balance at the
same time I treat wrinkles with
different types of lasers and
radiofrequency technology combined with
regenerative medicine technology such as
PRP or platelet-rich plasma if there is
a fold of skin that is overlapping I'll
perform a limited skin pinch type of
excision coming from a background in
ophthalmology I always emphasize to my
patients the importance of optimal
eyelid function for proper eye health
for example the simple action of normal
blinking is critical because the eyelids
function like windshield wipers to
distribute your tears evenly over the
front surface of your eyes proper
lubrication of the cornea which is the
clear part of the eye you see through is
necessary for optimal vision people with
an eyelid skin shortage complain of
having irritation such as a foreign body
sensation and dry eyes because the
eyelids can't function properly to
lubricate the surface of the eye
patients with upper or lower eyelid skin
shortage report that sleep is difficult
because the eyes don't fully close
leaving a gap resulting in irritation
mucous production and blurred vision no
surgeon is immune to dealing with
complications or unanticipated outcomes
however the optimal management of
complications is critical
much of eyelid surgery issues such as
skin shortage retraction or undiagnosed
ptosis can be managed through the basic
principle of restoring anatomy for
optimal appearance and function I find
that a lot of patients who come in for
revision eyelid surgery underwent
several attempts by the original surgeon
to improve the patient's condition with
ineffective surgical procedures which
often makes things worse when evaluating
a patient with difficulty with our
closure I look first at the immediate
management of the eye itself to ensure
preservation of vision and eye function
I look at specific anatomic deficiencies
such as skin shortage or internal tissue
scarring I determine if it makes sense
to wait and allow for tissue relaxation
to potentially improve the patient's eye
closure without surgical intervention if
there is a significant upper eyelid skin
shortage an option is to do a skin graft
in the lower eyelids the balance of
anatomic components were compromised
often requires procedures such as skin
graft lower eyelid support graft and the
repair of a canthal tendon or the
attendant supporting the eyelid in cases
where eyelid ptosis was not addressed at
the time of surgery I approach this
problem through ptosis surgery
procedures such as levator muscle
advancement or from behind the eyelid
with a technique called conjunctiva
Muellerectomy I typically perform a
revision eyelid surgery in my private
office surgical facilities I also
performed a surgery with local
anesthesia and LITE IV sedation people
coming for revision eyelid surgery are
often quite relieved that they aren't
going through general anesthesia again
although complications can occur with
any procedure I exposure and the
potential for compromising vision makes
the outcomes of primary eyelid surgery
and revision eyelid surgery more than
just about appearance restoration of
function appearance and character to
your eyes is possible in most situations
should you experience a problem after
undergoing eyelid surgery I hope you
found this information helpful thank you
for your question
 
