Dear Dr Seckel, I had a blepharoplasty done several years ago. I am happy because the eyelid bags are gone, but now my eyes have a sad look. Can anything be done to fix this. Thanks, Mary Beth, Dallas TX.
Dear Mary Beth,
Yes, the sad eyed look or hound dog eyes that happens to some people after blepharoplasty can be corrected. Of course the best cure is prevention. Modern blepharoplasty and eyelid rejuvenation techniques have been modified to prevent the sad eyed look so it does not happen in the first place.
To correct the sad eyed look a plastic surgery operation called a secondary blepharoplasty with a canthopexy or canthoplasty is frequently done. During this operation the ligament that supports the lower eyelid is tightened or pulled upward to pull the corner of the eye back up. In severe cases of the sad eyed look, more complex procedures can be required.
I have written a lot about the problem of preserving the shape of the eyelid during blepharoplasty and you may want to check the other blogs on this subject in the archives.
The results of blepharoplasty eyelid rejuvenation can be stunning and create a truly refreshed younger look to the entire face. Patients who seek blepharoplasty often complain of a tired look. The most common complaint I hear is that “people say I look tired when I am not”. The goal is to remove the tired look, the eyelid bags, the dark circles under the eyes, and tighten skin. Blepharoplasty alone does not remove wrinkles. Eyelid wrinkle removal requires resurfacing of the skin by one of many different new techniques including many different types of lasers.
One common problem following the blepharoplasty operation, the one you ask about, is that the operation can change the shape of the eyelid. In some cases, after surgery the outer portion of the lower eyelid turns down revealing too much of the white portion of the eye. Technically this is called scleral show, and if it is extreme it is called ectropion and can damage the eye.
Fortunately, the sad eyed look or hound dog eyes can be avoided by a newer blepharoplasty technique called the transconjunctival blepharoplasty.
Traditional blepharoplasty is done through an incision on the outside skin of the lower eyelid placed just beneath the eyelashes. The surgeon cuts through the skin and the eyelid muscle to get to the fat that is removed to lessen the eyelid bags. Often skin and muscle is also removed to lessen the amount of excess skin on the eyelid.
The problem with the standard scalpel blepharoplasty technique is that when the surgeon cuts through the muscle that supports the lower eyelid the support for the eyelid is often lost. In addition, the scarring produced by the surgery tends to pull the eyelid down. If the patient has a lax lower eyelid to begin with, the situation is made much worse.
The newer blepharoplasty, called the transconjunctival blepharoplasty is done very differently and avoids injury to the supporting eyelid muscle. The conjunctiva is the pink part of the eyelid on the inside. In transconjunctival blepharoplasty the incision for a blepharoplasty is made through the conjunctiva on the inside of the lower eyelid and avoids damage to the supporting muscle. The fat is removed or repositioned from the inside and the lid tightened and an arcus marginalis release performed to correct dark circles under the eyes. Laser blepharoplasty, that is using the laser to make the transconcunctival incision and tighten the skin and muscle, is becoming much more common today as blepharoplasty techniques continue to improve.
The benefit of the transconjunctival blepharoplasty is:
1. There is no visible scar on the outside of the lower eyelid
2. The eyelid shape is preserved
3. Healing time and recovery is usually quicker
4. Bruising is often less
5. The sad eyed look or hound dog eyes is usually avoided
It is very important that you seek consultation with a board certified plastic surgeon or occuloplastic surgeon to correct your problem. The canthoplasty and other operations to correct ectropion are very complex delicate procedures and should not be attempted by surgeons who are not specifically trained, expert and experienced in these procedures.
I hope this information is helpful. For further information visit my Boston Plastic Surgery Practice, read Save Your Face or contact me.
Boston, Massachuseets
Peabody, Massachusetts