Dear Dr Seckel, Yours is the most informative site on eyes I have seen. I had an upper lid blepharoplasty, skin excision only, and there is a scar on the outer aspect of both eyes. I had fat injections to the malar crow’s feet. I’m not sure if this scar is the access area the surgeon used but I now have lower eyelid descent - and degree of ectropion which is frightening. I’m wondering if fat was removed as well. Please help me if you can I would like to come and see you. Thank you. Linda, London, England.
Dear Linda,
Thank you for your question. I am so sorry to hear of the problem you have suffered following your eyelid rejuvenation blepharoplasty and fat injection but would reassure you that techniques are available to improve your scars and correct the ectropion. The most important thing for you to do is to seek consultation with a board certified plastic surgeon who is experienced in eyelid rejuvenation and eyelid surgery and laser eyelid surgery. I will be happy to help you with this offline.
The scarring you mention on the outer aspect of your eyes which occurs after excisional blepharoplasty and can usually be improved with a laser eyelid peel or laser resurfacing directly over the scar also called a dog ear. The benefit of using the laser peel of the eyelid scar to treat the outer blepharoplasty scar is that the laser also helps remove fine wrinkles and tighten the excess skin which commonly are left behind in the crow’s foot area following a blepharoplasty. Following the laser peel or resurfacing your skin would be red for possibly 10 days, but make up can be used after that to cover any pink that might remain for another 2-3 weeks.
The laser might also be able to be used on the malar scars but only if the ectropion is corrected. The laser skin peel can help with scar and wrinkle removal and the malar crows feet, but the skin is tightened as well and the skin tightening can pull down on the lower lid. This is not a problem if the lower eyelid is tightened first with a canthopexy but I would not do a laser peel on the lower eyelid or malar area and lower eyelid unless the ectropion was corrected first.
The drooping or descent of your lower eyelids or ectropion following your eyelid rejuvenation is most likely the result of scarring caused by the needle during the fat injection to treat the crow’s feet. The procedure to correct the ectropion is called a canthopexy or canthoplasty and involves tightening the lower eyelid and restoring it‘s position by tightening the canthal ligament. The canthal ligament supports and holds the lower eyelid against the eyeball. If there is significant scarring and tightening of the eyelid skin from the fat injection the scarring might need to be released as well.
I am terribly sorry to hear of your experience with eyelid rejuvenation but want you to know that techniques are available to help you. For others who read of your experience on this website I encourage them to read my previous blogs on fat injection and soft tissue filler injections into the lower eyelids. To date I have only received questions about problems with these techniques. The lower eyelids are very complex delicate structures and blind injection into this region carries risks. While I am sure there are many people who have had happy results, people need to be aware of the risks.
Thank you very much for your important question. For further information read Save Your Face or contact me.
Boston, Massachusetts