The Most Common Causes of Eyelid Retraction after Lower Eyelid Surgery, and How to Avoid Them

For more about Dr. Prasad's background and training, please go to:

New York oculoplastic and reconstructive surgeon Amiya Prasad, M.D. reviews the cause of pulled down eyelids after eye bag surgery; the differences between transcutaneous blepharoplasty, and transconjunctival blepharoplasty; what causes lower eyelid retraction, and ectropion; and how the way lower eyelid surgery is performed can affect the shape of and health of the lower eyelids:

0:21 - Introduction to pulled down eyelids after eye bag surgery

0:33 - The cause of always visible puffiness under the eyes

1:02 - How high demand for lower eyelid surgery results in more surgeons willing to perform it

1:48 - Dr. Prasad's credentials in cosmetic oculofacial plastic and reconstructive surgery, as well as his experience in treating under eye bags

2:47 - How the way most lower eyelid surgeries are performed is the most common cause of pulled down eyelids after surgery

3:02 - What transcutaneous blepharoplasty is, and how it is performed

3:30 - The risks of transcutaneous blepharoplasty

3:43 - What lower eyelid retraction, and ectropion are

4:06 - What transconjunctival blepharoplasty is, and why Dr. Prasad prefers this approach

4:39 - The benefits of transconjunctival blepharoplasty

4:54 - How lower eyelid skin removal to treat wrinkles can be another factor in lower eyelid surgery complications

5:07 - How under eye wrinkles being caused by redundant eyelid skin is a common mistake

5:21 - The cause of under eye wrinkles

5:45 - How Dr. Prasad addresses eyelid skin wrinkling using lasers, and PRP

6:06 - What PRP or platelet-rich plasma is, and its benefits for lower eyelid skin rejuvenation

6:44 - Conclusion

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[chiriquikis.-.]

great video ! my mother is showing signs of this on her right eye and although i am sad for her, it is good to be well informed on the topic.

[pobox]

Hello Dr. Prasad. I had a lower blepharoplasty performed by a Double Board Certified Plastic Surgeon (mistake #1) 6 months ago. I also had a deep plane facelift. Back in 2012 I had basil cell removal surgery (MOHS) under my left eye right where the lower lashes are in the corner closest to the nose. Anyway, I had listened to your videos BEFORE I had this surgery and made sure this doctor performed the transconjunctival procedure of which he said yes. He knew I had that surgery back in 2012 and when on the surgical table before my surgery, he reminded me of that basil cell surgery and I said that I would prefer if we do not do the eyes of which he told me he was going to do the eyes in a way that would be no problem so I agreed with him and said okay you are the surgeon (mistake #2). I am not sure which way he ended up doing it however now I have lower lid retraction and entropion in my left eye, dry eye syndrome, lashes scratching my eye, unclear vision and a rounded eye (losing my beautiful almond shape eye). The right is not near as bad however after seeing ophthalmologist did say one eye lash was going in my right eye too. I doubt I would need extensive work on my right eye as I do not feel the eye is round but what I can say is both my eyes have hallow underneath now and make them appear as "set in" ... It's awful. I am so depressed and am beside myself with what he did to me. I also have scar tissue built up on my sides of eyes where the stitches were from the face surgery. So needless to say I am a hot mess! I am 64 years old. It's not only cosmetic with me and know that I will need to have this revision surgery performed on one or both eyes. My questions would be 1) do you think you could help me? 2) what is the benefit of using your own skin (from roof of mouth) over Enduragen? (I ask because now I have dry mouth syndrome which I never had before-- so the surgery caused this.-- not sure if you could use the roof of my mouth? 3) I know you said you use hydro fillers -- I have never used a filler in my life -- nor was I planning to -- so with that does that mean you would have to keep the fillers up year after year? I live in Chicago and would not be able to fly to New York or Virginia every year to have that done? Okay .. please respond. I know I have a lot of questions but this would be helpful for considering you as my surgeon. I want one of the best and I think highly of you. I appreciate your time and videos!

[MegaCosmoVision]

I read retraction can also happen with transconjunctival if you are the type to develop scar tissue, so this is a risk, even that scarless blepharoplasty could still cause it due to scar tissue pulling down the eyelid plus fat no longer being there giving support to the lower eyelid

[rochellehoenig]

Hi I had a lower eye blepharoplasty 4 weeks ago in Malaysia,
I like in Australia.
I has this done by an oculoplastic surgeon.
I feel my under eye lids may have what you are describing.
My eyes water all the time and now my bottom lashes touch my skin

[DSauve]

I never had a lower bleph, but my lower eyelids are retracted on the lateral parts, how is that possible? Never had surgery on my eyes

[debrahudson]

I had a lower eye blepharoplasty done Nov 29. 7 days later I had a follow up appointment with my surgeon and mentioned I had some bleeding from the eye. She said it was probably an internal stitch. 3 days later I had an eruption of a vein or artery in my eye and had to have emergency surgery to stop the bleeding. INCISION AND DRAINAGE, HEMATOMA, SEROMA, OR FLUID COLLECTION. How common does this occur? I feel like I now have the eyelid retraction in that eye. I am worried about future problems as I get older. Is there any? Im guessing, I will need surgery again to fix the retraction but how about long term?

[reginaful]

Had lower eyelid blepharoplasty performed two days ago. I see one eye is normal, the other one shows evidence of orbital prolapse of lower lid. I'm so upset. Now what do I do? How can it be resolved?

[sharonchavarria]

Hello Dr Prasad
I had upper and lower done fourteen months ago. I have what you are describing. The surgeon did a small nip & stitch three months and it is still very droopy. Then just a second revision two weeks ago and still the same problem. My eye is always red and very irritated. She mentioned to tape and eye massages daily. It is only a temporary fix for the day.
What is my third option?

[jacksonnuli]

which type of stitches you use for transconjunctival approach ?

[elfyhalim]

Hi Doc. Nice and clear explanation. May i ask your advice please? I have chemosis for 1 year after lower blepharoplasty with various of oral treatments ( eye drops such as Hialid / Hyalub and various type of steroids including steroid tablets ) with 2x cutting the blister skin to get the liquid out, but the chemosis still stay the same. Most of the times the colour turns red, but it will be gone everytime i drop Oculenta. I hope you can give me some ideas what is actually might has happened to my eye ( only 1 eye got chemosis ). I really appreciate for your feedback and help. Thanks.

[judithcripple]

I am going thru this right now. Eyelids are extroverted. Don’t close all the way esp when I am asleep. Have had 3 surgeries on eyelids. Eye pressures are very high 33 & 48. Eyes are extremely dry HELP PLEASE

[Lucky-uffz]

What your thoughts on SOOF lifts? Could you make video on this? I recently had a consultation and was recommended to have a transconjunctival blepharoplasty with SOOF lift

[anum]

Dr, . Mild smile lines. Any treatment ?

[donamathew]

Great videos, sir how do you decided on the end point of fat removal from lower lid trans conj blepharoplasty?
How often have you encountered with IO muscle during the procedure Sir?

[dlemmon]

Dr. Prasad, 6 wks ago I had an Board Cert Octoplastic Surgeon well known, perform a full bleph and fat transfer. All of the FT has reabsorbed and my lower bleph bags NEVER went away. He made incisions on both lower lids both R. and L. sides, but now trans incision (under the lash line) was performed. I paid exhorbant amount of money and the bags weren't addressed. It was done subcutaneously. I have very tight skin around my eyes and I dont understand why he couldnt do it conjuntivally. Is there anything I can do at this point, as very little was successful. He is asian and does not speak well English.

[mukeshkushwaha]

Amiya sir,
Just few question I need to ask,
Is eyes shape changes thought our lifetime,
I mean I have seen certain peoples eyes shape changes as they grow older, as sign of maturity.
And does it represent the maturity or fitness the more fit you become the eyes shapes become more small and beautiful.
And what make a face beautiful, is it
1 ) indication of fitness, changes in jawline, muscle on face become noticable, glow on face, cheeks become bigger, etc
2 ) some people face contains emotion, because our face is indication of emotion and some people face is natural build around a certain emotion .
3 ) Or its just a that Golden ratio plays a huge role in beautiful face .
Or all that combined .

[Ervingirl]

Can fat grafting still be done by using you surgery method from inside the lower eyelid? I was told by another plastic surgeon that he could only do fat transfer by doing the surgery on the outside below the lower lash line. I do not have eye bags, but deep hollows under my eyes which makes me look tired.

[mastermindmasterpiece]

Doctor, is canthopexy ever needed under a transconjunctival approach, with no skin pinch?

[rizwanaakhtar]

Hi I had plz can u advice plz ..just a week I had my lower blepharoplstry and now my both lower eyelid are dropping downwards and they look round and scary to me...Plz can suggest me what can do and what I say my doctor ...Thank so very much

[Whysoserious]

Dr, can u get rid of dark circles that are caused by hyperpigmentation only?