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Will Eyelid Shape from Lower Lid Surgery Return to Normal Without More Surgical Intervention?
I recently had a lower lid lift along with a MACS lift. I had quite a bit of swelling
in both eyes with a blister type growth appearing in the right eye. My surgeon is out of state
but he did arrange for me to see another plastic surgeon in Florida who recommended I do upward
massage. The pictures are at 5 weeks post op. Can I expect more improvement with upward
massage or will further surgical intervention be needed to correct this? If so, what would
be most recommended?
Thank you for your question!
You've undergone a MACS lift facelift and you've undergone eyelid surgery and you're
in a situation where you're asking whether your eyelids will return to normal or to the
prior level to where it was before your surgery. The photos you submitted and I understand
that you are seeing a plastic surgeon who is not the original plastic surgery but who
is assisting in your post-op care and you are recommended to have massage. That's okay.
Not knowing when you had the procedure relative to the photo you submitted, I can share with
you that in my practice, as a specialist in eyelid surgery and face lifting surgery, I
get to see a good number of people who come for revision for their eyelid as well as their
face lift. And the typical situation that I come across with someone who had their eyelids
pulled in that direction is that within several months of the surgery, it become very clear
that even with aggressive massaging or even steroid injections that the eyelid will not
generally return to its original position. And there's a couple of basic concepts that
account for that.
When you talk about having a MACS lift, the MACS lift is essentially one of those shorter
scar face lifting procedures where a lot of aggressive lifting of the cheek area is performed.
You can actually see this in the doctors who invented this procedure wrote a couple of
books about it and articles that when so much cheek skin is recruited, a lot of times skin
has to be removed because it bunches up around the eye. The issues I have come across for
people who performed this procedure and those patients finding their way to me is that unfortunately,
the cheek ends up descending. And when it descends, it causes the pulling of the lower
eyelid. When that happens, there's a relative shortage of tissue to support the lower eyelid.
Now, having had lower eyelid surgery at the same time, there are other factors that can
contribute to the relative position.
As a conservative measure, I agree that massage is the first step to help, basically, softening
scar tissue so that there's tissue remodeling and the eyelid comes up as much as possible.
Again, since I don't know the time frame of the original surgeon, I can't speak exactly
what I can anticipate but I'll tell you generally, the patients who come to me are not fully
satisfied about how much their eyelid got higher even with massage and that they typically
need some type of revision surgery such as canthoplasty or canthopexy where the lower
eyelid has t be reattached to the bone or grafting procedures such as the placement
of an enduragen graft or a middle lamella graft. You know, there are a lot of different
things that are necessary to restore the integrity and position of the lower eyelid. Very often,
they also need some skin grafting.
So although these may sound very aggressive and are basically the last choice in making
the decision about the situation of the lower eyelids, ultimately, I always tell my patients
who come for these opinions is that there are two key elements to understand. One is
that eyelid position is critically important for eye function. That means that the eyelids
being in a position where the tears are able to distribute properly when the eyelids are
going on a downward slant, the tears cannot be distributed as effectively as when they
are on a better position. So that's a critical part and the second part of this is that there's
a basic rule that eyelids that look good function well. So anatomically, if the eyelid is in
a good position, it'll look better and it'll function well as what its main purpose is
to protect the eye and to ensure the health and integrity of the eye.
So for now, certainly massaging is the right thing to do but I would say, be prepared and
get some additional opinions if you need to about what to do about the position of your
eyelid. Again, another part I also have to share is that some people like their eyes
to be relatively rounded or kind of this shape where it almost becomes the new normal in
some communities of people who had eyelid surgery. So as long as that there's proper
lubrication of the eyes and you are satisfied with the results, you don't have to be so
aggressive. So again, it's about your personal perspective and making the decision as times
go on as the healing process progresses.
So I hope that was helpful, I wish you the best of luck and thank you for your question.