Eyelid Revision Surgery
Patients often notice that their eyes appear very prominent and their eyelids are retracted, revealing a great deal of white under the center of the eye. This can occur naturally when someone has relatively small cheekbones or be exacerbated after blepharoplasty (eye lid lift) surgery. In addition to appearance concerns, the patient can experience constant pain, redness and irritation.
At the International Orbital Institute, Dr. Raymond Douglas leads our team of eyelid revision surgery experts. He has taken care of thousands of patients by using innovative and novel techniques. Specifically, due to his cutting-edge techniques in revision eyelid, he has been invited to lecture and teach at medical conferences around the world.
When it comes to revision eyelid surgery, it is vital to find an oculoplsatic surgeon who specializes in this complex area of surgery. Revision surgery is more complex and should only be performed by an expert, like our surgeons at the International Orbital Institute. Below is information about the different complications that can occur from primary eyelid surgery and how Dr. Douglas can help correct those issues with revision surgery.
Frustration of eyelid revisions
The biggest frustration many people face is that they do not anticipate some of the issues arising with their eyelids will require revision. Sometimes, these issues are due to trauma, previous surgeries, or being born with certain features. Regardless, there is hope for improvement. Every person’s treatment must be customized according to their needs and to make the journey easier we offer Skype consults and in-person specialized care.
What causes eyelid retraction?
Eyelid retraction can be due to variety of causes. Whether it be due to a car accident or previous botched eyelid surgery, there are basic algorithms which must be considered for optimal outcome. Often, failure to address one or many of the elements can lead to pain and inability to close the eyes.
Algorithm for Eyelid Retraction: 5 Elements
1. Negative Vector/Prominent Eyes
Patients with prominent eyes are at the most risk for having complications and experiencing eyelid retraction. When eye prominence is severe, it can compromise the eyelid reconstruction. For this, we have novel ways to reduce they eye prominence.
Our technique, orbital decompression, reduces the volume or tissue behind the eye allowing it to set back into a normal position. Although this type of surgery is extremely unique, Dr. Douglas does hundreds of these specialized cases per year. This surgery is typically done on an outpatient basis and is a considered very safe. In fact, moving the eye to a more normal position may be a safer alternative for many patients where conventional surgery would predictably fail.
Our group performed a study in 153 patients showing that removing tissue behind the eye returned the lower eyelid to a normal position. In the example below, no eyelid surgery was done, but rather just moving the eye to an improved position resulted in a more natural appearance and improved lower eyelid position.
2. Volume Collapse
Volume collapse occurs when too much fat is removed during a surgery such as blepharoplasties or from other injuries. It can cause an unwanted deflation of the lower eyelid or hollowing of the upper eyelids but it can be improved by a variety of techniques utilizing semi-permanent or permanent fillers.
Paralysis occurs due to surgery or injury to the muscle or nerves around the eyelids. This is problematic because muscles around the eyes allow us to squeeze the eyes closes and to blink therein protecting the surface of the eye. When there is paralysis of these muscles or nerves, the eye can become very dry or exposed which can result in severe pain. Paralysis is not easy to overcome but as part of our facial nerve treatment team we have acquired an enormous experience helping patients close their eyes and relieve the pain. Treatment can often involve re-innervation of the muscles or others static ways to make the eyelids function better. Assessment and treatment methods for paralysis are instrumental in planning for eyelid revision surgery.
4. Scarring of Middle Lamella
Scarring can occur in many locations of the eyelid. When it occurs in the middle of the eyelid, the middle lamella, it can cause irregularities between the eyelashes and the bone of the orbit.
As you can see in this patient, scarring prevents the eyelid from moving upward when pushed by one’s finger. The scarring can be overcome with many options, including “biologic remodeling” where a series of injections is used to stretch and remodel the scar tissue to a point that other interventions may not be needed. There are also other options to raise the eyelids and overcome the scar tissue. Many options are available depending on the patient’s condition.
5. Skin Shortage
In many cases, eyelid skin is removed in an attempt to reconstruct following an accident or skin cancer removal. Skin shortage can also occur when too much skin is excised in attempt to remove wrinkles. No matter the cause, it is sometimes necessary to replace skin. While this is often not the first option, we have pioneered techniques to do this in a safe and aesthetically acceptable manner. We use methods to biologically remodel the added skin so it blends in almost imperceptibly.
The patient below had previous cosmetic surgery that resulted in eyelid retraction and an appearance that was not satisfactory. Analysis demonstrated she had a good vector and minimal scarring of the eyelid to the orbital rim. However, she suffered from paralysis, skin deficiency, and moderate volume collapse. Considering these findings, our goal was to restore the elements that were problematic. As a result, she underwent a hard palate graft to support of the eyelid and increase volume, a skin graft to replenish the shortened eyelid skin, and filler (a combination of fat and hyaluronan) to replace volume. This resulted in an improvement in her appearance customized to her needs.
This patient suffered from a car accident and trauma causing 3 of the 5 elements of eyelid retraction. She had eyelid paralysis, mid-lamellar scarring to the orbit, and volume collapse. In order to provide a long-term solution, we focused on the problems that could be addressed. We addressed the scar by using biologic remodeling which resulted in a supple eyelid and improved function even when smiling. We also added volume and support to the lower eyelid to provide additional improvement.
This next patient underwent multiple previous eyelid surgeries seeking a cosmetic and natural improvement. She was seen by many other specialists in the past who attempted to correct the lower eyelids, but was unfortunately left with paralysis and volume loss. We undertook biologic remodeling and supported the eyelid to achieve a superior functional and aesthetic result.
Eyelid Retraction with Prominent Eyes and Severe Volume Collapse
This gentleman was born with very small cheeks and poor support to the lower eyelids and eyes. Through aging, the eyelids became lax causing them to sag and resulting in lower eyelid retraction. We focused on the elements of severe volume collapse and eye prominence by performing a fat and bone decompression to improve the position of the eye as well as augmenting the cheek with an onlay implant. In this manner, by focusing on the elements that this patient was lacking, we were able to achieve a superior result.
Post Blepharoplasty Eyelid Retraction and Eye Prominence
Patients who have undergone eyelid surgery with too much skin removal often have a result of prominent eyes, which prevents them from fully closing their eyes. This patient’s daily activities and sleep were greatly impacted due to severe dryness of the eyes and exposure. As you can see, she was unable to completely blink.
She had all five (5) elements causing eyelid retraction, including a negative vector, moderate volume collapse, mid-lamellar scar from previous surgery, and lastly paralysis. She had undergone five (5) previous procedures to correct her eyelids without any success. This patient’s circumstances were difficult but we were able to remove tissue from behind her eyes to allow a more normal position and appearance. This surgery was done as an outpatient surgery in approximately 90 minutes. The improvement was remarkable and both her appearance and function improved. The patient was finally able to sleep comfortably.
This following patient could not close her eyes and was suffering constant pain. She had undergone multiple procedures previously with no success. However, it is important to note that none of her previous surgeons addressed the negative vector. By reversing the negative vector, we were able to provide an improved lower eyelid height and better function. The patient was thrilled with her results.
Dr. Douglas is an eyelid revision surgery expert and has developed several customized strategies to improve the overall appearance and function of the eyes.
If the eyes are prominent, he can consider moving them into a better position. However, eye prominence is critical as it will dictate whether surgery will be successful. If the eye is prominent, many surgeries will have little chance of success. But moving the eye back even a couple millimeters can dramatically change the appearance and function of the eye. This surgery takes very little time and can be a very safe alternative.
Schedule Your Revision Eyelid Surgery Consultation Today
If you are unhappy with the results of a previous eyelid surgery, Dr. Douglas and his team are here to provide you with the personalized care you deserve. Please contact us at (310) 657-4302 to schedule a consultation with Dr. Douglas to learn how he can help you.
For patients who live out of town or out of the country, we offer initial Skype consults so you can meet Dr. Douglas from the comfort of your own home.