My eyes are dry since my eyelid surgery. Is there any help?
Dry eye after a recent eyelid surgery is not necessarily cause for alarm, but certainly something you and your doctor should monitor together and take steps to relieve. Eyelid surgery is a complex procedure that has many rewards and is considered very safe, yet it’s not without risk. This is the case of every medical treatment or surgery. It is likely that your surgeon discussed with you the possibility of dry eye and included this among the possible issues after surgery in your surgery consent. Hearing about it pre-surgically and experiencing post-surgically are two very different realities.
At the beginning of your post-operative healing, dry eyes, swelling, and lids not closing properly are common experiences, but usually these are temporary and naturally resolve as the swelling goes down and you heal. Think of your eyelids as windshield wipers that move tears over the eye surface. With surgery, the eyelids swell and function less well as tear movers contributing to dry eye sensation. The swelling generally subside sufficiently in the ten days after surgery to make a noticeable difference in eye comfort. However, swelling is not the only reason the eyelids may not function well. Certain eyelid surgeries actually injure the motor nerves to the orbicularis oculi muscle close to the eyelid margin. These injuries can be temporary or permanent and also effect how well the eyelids move tears over the eye surface. It seems that some of these injuries do get better with time but some persist and can permanently contribute to dry eye. Symptoms that persist longer than 6 months tend to be permanent. Because of this, we can think of post-operative experiences as immediate (within the first six months) and long-term (thereafter).
The way to address a concern over dry eyes depends on when you are experiencing this issue, and the actual basis for the symptoms. This means that a detailed eye exam by a board certified ophthalmologist is needed to assess these symptoms. Normal post-operative dryness can usually be helped with over-the-counter eye drops. We also strongly recommend you talk to your surgeon openly about your healing process and remain in regular communication. Dr. Steinsapir closely follows his patients to monitor their progress, answer questions, and be available to address any complication in the unlikely case that they arise. As we said, no surgery is without risk, and a surgery can tip a compensated dry eye. For this reason, Dr. Steinsapir recommends that eyes be thoroughly assessed before surgery to look for evidence of dry eye. Knowledge of the dry eye status before surgery should influence the surgeon to perform more conservative eyelid surgery, prompt a referral to a cornea specialist when needed prior to surgery, and in rare cases, recommend against eyelid surgery in the most severe cases.
In communicating with your surgeon, if artificial eye drops do not seem adequate, he or she may prescribe ophthalmic ointment before bed. In some cases, tear drains can be temporarily closed to improve symptoms. If these do not work, there are additional mechanical treatment options such as taping of the eyelids at night or swimming goggles at night in the most extreme cases. Long term when these measures do not provide sufficient relief, careful assessment for eyelid reconstruction may be indicated. The solution will depend upon your symptom severity, and the timing and precise anatomic cause of the problem. A range of options are available to improve eyelid closure with blink, which helps spread tears over the surface of the cornea and contributes to eye comfort.
If you wish to seek a second opinion, Dr. Steinsapir is available to assess your particular situation. He provides compassionate care whether you live locally or find it necessary to fly to Los Angeles for his assessment and input. He regularly helps individuals who require reconstructive surgery and corrections, and he is also thoroughly knowledgable on what to expect as part of the normal healing process. Your reconstructive surgery, when necessary, can be performed in his state of the art office based surgery center or on an outpatient basis at the Ronald Regan UCLA Medical Center, where is on staff. We invite you to call us today to schedule a time to discuss your particular concerns and options.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
What is supratarsal fixation and how does it differ from anchor blepharoplasty?
Supratarsal fixation is really an antiquated method that invites the surgeon to form a crease that is simply too high for virtually every patient. The natural eyelid crease is caused by connective tissue fibers that firmly connect the eyelid platform skin to the underlying levator aponeurosis tendon. This tendon connects the upper eyelid to the levator palpebrae superioris muscle in the orbit. This muscle is responsible for opening the eyes. The connective tissue fibers from the levator aponeurosis to the skin form the upper eyelid crease and support the eyelid platform skin and upper eyelid lashes. If these fibers stretch out, which happens as we age, or are not present, which is seen in some Asian eyelids, the skin of the eyelid platform will be loose and the eye lashes will hang down (eye lash ptosis).
Anchor blepharoplasty is a blepharoplasty technique where the levator aponeurosis is exposed at the time of surgery, and stitches are placed from the cut upper eyelid platform skin and muscle to the exposed levator aponeurosis. By doing this in a very precise fashion, the upper eyelid lashes are supported and perky and the eyelid platform skin is snugged over the eyelid platform much like someone might pull a bed sheet taut. This technique requires both absolute precision to be done well and a very detailed knowledge of eyelid anatomy. In Dr. Steinsapir’s experience less than 2% of all eyelid surgeons are able to perform an anchor blepharoplasty.
So-called supratarsal fixation should be another name for an anchor blepharoplasty. However, it is seldom actually practiced this way. Surgeons often interpret this procedure to mean “above the top of the tarsus.” Effectively they do away with the surgical dissection needed to identify the levator aponeurosis. Instead they interpret supratarsal to mean sewing the cut edge of the eyelid platform skin somewhere above the top of the tarsus. Effectively this often means sewing the skin to something much more superficial such as the orbital septum. This is not the same thing. The levator aponeurosis is a mobile structure. When you open the eyes, the levator aponeurosis slides up and back. Anything attached to the levator will also slide up and back. When the eyelid platform skin and underlying muscle are accurately attached to the levator aponeurosis, the eyelid platform skin stays well snugged and the eye lashes well supported whether the eyelids are open or closed. In contrast, if the skin is “supratarsally” fixed, the skin is snug (or too tight i.e. the eyelids are short of skin) when the eyes are closed and loose when the eyes are open.
Another issue with so-called supratarsal fixation is that it is often associated with a surgical look. This is because the upper eyelid crease is made too high. The top of the tarsus is 10 mm from the actually eyelid margin. To fixate above the tarsus, the crease is being made north of 10 mm. In addition, with healing the crease normally creeps even higher by one or two millimeters. It is not unusually to see crease height of 12 or even 14 mm. This height is at the expense of the upper eyelid fold which is often surgically wiped-out. This makes the upper eyelid look too hollow-think Barbra Walters.
In contrast, a properly done anchor blepharoplasty can be done at almost any height above the eyelid margin with preservation of the upper eyelid fold.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
Asian eyelid surgery is not about Westernizing the eyes!
We’ve said this before, but it’s worth repeating: Asian eyelid surgery is not about westernizing the eyes. In fact, there is no one standard approach to Asian eyelid surgeries such as blepharoplasty and double fold surgery, because there are no two people with identical sets of eyes. When we refer to “Asian eyelid surgery,” what we mean is that certain features more common in the shape and contours of Asian eyelids must be uniquely considered and comprehensively understood by an experienced oculofacial surgeon for optimal results.
All kinds of individuals seek cosmetic eyelid surgery in the form of blepharoplasty, lidlift, reconstructive surgery, double fold surgery, and other procedures designed to enhance the appearance and functionality of the human eyelid. Eyelid surgery is about improving your natural eyelid structure in a way that compliments your natural appearance. The end result is a bright appearance that seems fitting for you and does not look “surgical” or “westernized” at all.
Your specialized oculofacial surgeon’s attention to Asian eyelid surgery in fact means the opposite of westernization: your treatment should not be a cookie-cutter “one size fits all” approach, but rather one that takes your natural eyelid shape into account and seeks to enhance it rather than transform it. While Asian eyelid surgery does not aim to “westernize” one’s features, it calls for exacting and meticulous attention to detail, as well as experience with proven results. A common error that Dr. Steinsapir is often consulted for to provide a correction is double folds that are made too high. In almost all cases this is caused by a surgeon who fundamentally does not understand the surgery. The surgeon may be inexperienced or simply lack the necessary grasp of what is required to make a natural double fold. Sometimes the inexperienced surgeon is simply following the wrong textbook and intentionally makes the crease incision too high as a result. Asian eyelid creases need to be place low in order to create an natural appearing double fold.
We invite you to look through Dr. Steinsapir’s unretouched before and after photos of various Asian eyelid surgeries. You can judge for yourself, but we believe you’ll find the results to all be very natural and fitting for the individual. The key to Dr. Steinsapir’s success is years of experience in eyelid surgery that includes Asian eyelid surgery as a specialization, with multi-fellowship training, prestigious education, an artistic eye, and a prioritization of individually designed treatment to enhance each person’s unique features. Call us today to schedule a consultation with Dr. Steinsapir and achieve natural results that enhance your personal attributes.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Beverly Hills where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
What does Dr. Steinsapir think of the “Madonna Lift?”
For the last few years, the “Madonna Lift” — yes, named for the famed pop star — has received attention for purportedly dramatic results akin to an eyelid lift without the surgery. The procedure itself involves fractional CO2 laser resurfacing, with a goal to tighten the periocular skin in the eyelids and adjacent facial regions. Marketing claims for this procedure promise that it will give the effect of an eyelid lift through use of light columns to treat and tighten the skin. Claims include a diminishing of wrinkles, tightening of the skin, reduction of under eye circles, and elevation of the eyebrows. In essence, we are talking about the full benefits of an eyelid lift but without any surgery at all.
Does the Madonna Lift live up to the hype? Reasonably, the Madonna Lift can make a modest difference in your eyes’ brightness, but individuals undergoing the procedure might feel that it didn’t seem worthwhile. To get real results cosmetic procedure must address the root causes of your concerns. The best and most natural results come from addressing actual issues — which may include excess tissue or tissue deficiencies or both; stretched, sagging, and sun-damaged skin; ptosis; a drooping brow; or other concerns. Short cuts may help but they can also be disappointing because the lack the power to make a real difference.
Dr. Steinsapir is a leading advocate of minimally invasive facial cosmetic procedures, including nonsurgical procedures like under eye Restylane, the chemical peel, and Microdroplet BOTOX when indicated. There are many nonsurgical procedures with minimal downtime that can make a huge difference in your appearance. However, the key to satisfactory results is catering to your unique facial structure and goals, while choosing the best procedure to match your needs (whether surgical or not)–rather than setting your heart on a procedure full of promises but that may not be right for you.
The Madonna Lift is not a substitute for surgery if that is what you actually need. This is just another example of a modest procedure with a catchy name. For real results, we strongly encourage you to seek a personal consultation with a physician who is an eyelid specialist and can advise you on a personalized treatment plan. This may or may not include eyelid surgery, but the key is that your treatment will be based on your needs rather than a promise of a one-size-fits-all cure with a catchy name.
Dr. Steinsapir is an international leader in both eyelid surgery and minimally invasive, nonsurgical facial cosmetic procedures. Much of the appeal of the Madonna Lift is the absence of surgery, and it’s of course understandable that you may be hesitant to consider surgery. Dr. Steinsapir’s philosophy is that all treatments should be both individualized and minimally invasive. What does this mean? If surgery is not indicated, he will not recommend it. And when surgery is indicated to address the cause of your concerns, he opts for a treatment that is conservative and preserves as much of your natural tissue and eyelid contour as possible, enhancing your features, speeding up recovery time, and avoiding the “surgical look” famed by gossip magazines. Many people see phenomenal results from an upper eyelid blepharoplasty and related eyelid surgeries, and many also see incredible improvements from nonsurgical procedures like undereye Restylane and an individualized chemical peel. The bottom line is, you may or may not need surgery to get the results you desire — but for an outcome that meets your needs, you should never limit yourself to one procedure just because it was marketed to you. For the best results, consult with a leading oculoplastic surgeon to determine which treatment plan is right for you.
We invite you to consult with Dr. Steinsapir today, a pioneer in minimally invasive cosmetic facial procedures with particular attention to the eyelid and its balance with the rest of the face. Dr. Steinsapir has proven results for both surgical and nonsurgical cosmetic facial procedures; and his friendly, approachable, and honest demeanor will help you feel comfortable asking questions, receiving answers, and planning for the procedure(s) right for you.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I have had a heavy upper eyelid since childhood. What are my options?
There is often confusion regarding what part of the eyelid is heavy. Eyelid surgeons draw an important distinction between a full upper eyelid fold (which is actually part of the eyebrow just below the eyebrow hair) and a heavy or ptotic eyelid margin. Ptosis means fallen and it is a general term than is used to describe a number of anatomic issues. How we address a ptotic upper eyelid margin and how we deal with a heavy eyebrow are very different. Upper eyelid ptosis where of margin of the upper eyelid rests low on the eye itself, is often present from childhood onward. The condition can pose both aesthetic and functional problems. Depending on the nature of your case, you may be dissatisfied with a “droopy” appearance of the eyelid, you may have concerns about asymmetry noted by other people, or you may have visual impairment and diminished peripheral vision. Heavy eyelids may be described as “bedroom eyes,” or sleepy eyes. Because the heavy eyelid convey a lack of attention, the presence of upper eyelid ptosis can be undesirable in both social and work situations. In contrast, an eye that is open correctly makes you look alert, interested, and engaged and is socially desirable in both work and social situations.
Ptosis usually does not go away on its own, particularly if this is a problem you’ve had since childhood. Ptosis can also develop after childhood. Considering how the upper eyelid tendon in held in the eyelid, it is actually quite amazing that more people do not have this condition. After a few million blinks of the eyelids, it is common to see some degree of upper eyelid ptosis. If you have a bothersome heavy upper eyelid and are beginning to consider your treatment options, it is important to research upper eyelid ptosis and clearly understand your choices. Ultimately there is no substitute for consulting with a qualified oculoplastic surgeon because every eyelid is different.
Correcting eyelid ptosis requires upper eyelid surgery. The challenge is determining the best approach that is right for your needs. This is not a place for having work done by a non-specialist lacking training, skills, and experience. Having ptosis correctly diagnosed increases the likelihood that surgery will correctly address your issues. Having things done the right way the first time is so much better than needing to undo the wrong surgery. Ptosis surgery can often be done in conjunction with other cosmetic eyelid procedures. The surgery will elevate the eyelid to an appropriate, natural level. It can also address eyelid asymmetry. Having the heavy eyelids corrected can make a huge difference in your confidence level, the business world, and personal interactions.
The first step is to consult with a cosmetic surgeon who specializes in eyelid surgery, including concerns related to ptosis, heavy eyelids, and asymmetry. At your consultation, your physician should give you a close and thorough examination, discuss your options and probable outcomes, and the likelihood of a surgery’s success and factors that can complicate surgery. The doctor will also make a formal diagnosis at this time, which will identify the ptosis and any compounding issues. For example, some individuals also have a heavy brow or dark under-eye circles, which may exaggerate the problem. Your surgeon should specialize in understanding on how each part of the face functions and relates to the other parts, and also advocate for nonaggressive surgery for natural-looking results. He or she can then design an individual treatment plan for you that leaves you with an overall balanced look.
The first step really begins by seeing the right surgeon. The key to being happy with your results is to never take a shortcut in choosing a surgeon. Your surgeon must be a true specialist in ptosis correction, and similarly will not take any shortcuts or use a “one size fits all” approach to your care. It is important to understand the value of seeing an aesthetically oriented, fellowship trained oculoplastic surgeon. The plastic surgeon who did your girlfriend’s breast surgery or nose is all too often the wrong choice because they lack specialized training in ophthalmology and in oculofacial surgery. To be a fellowship trained oculoplastic surgeon means the surgeon is board certified in ophthalmology and has spent a minimum of two additional years training in eyelid plastic surgery. Dr. Steinsapir is board certified in ophthalmology and completed three years of training in oculoplastic surgery fellowships and two additional years of cosmetic surgery fellowship training. This advanced training early in his career has helped propel him to the forefront of his field.
A highly qualified cosmetic eyelid surgeon is the best option. Surgeons do vary, so it is recommended that you review unretouched before-and-after photos of eyelid surgery; spend time with the surgeon beforehand discussing your options, plan, and follow-up care; and understand your doctor’s treatment philosophy, which should advocate for a nonaggressive, individualized approach.
Dr. Steinsapir is highly qualified to treat eyelid ptosis, asymmetry, and related concerns. With particular attention to individualized care, multiple fellowships in eyelid surgery, and a specialization in ptosis correction, he can help you with your goal to realize a bright and natural appearance. Dr. Steinsapir is internationally regarded as a top eyelid surgeon. Call us today to schedule a consultation and finally take that next step in addressing your longstanding concern. You shouldn’t have to wait any longer.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
I am unhappy with my eyelid surgery. What are my options?
Eyelid surgery is one of the most popular cosmetic procedure today. It has the potential to provide extremely positive results that rejuvenate your appearance and make both an aesthetic and functional difference. Eyelid surgery can be very technical. Your surgeon may also be surprised by the disappointing outcome of your surgery. If you have had eyelid surgery in the past, such as an upper blepharoplasty or Asian eyelid surgery, but are dissatisfied with your results, help is available.
First, allow your eyelid surgery to heal. The initial healing after surgery can be a time of uncertainty. Recovery takes you out of your normal schedule and routine. Friends and family can make inappropriate comments that lead to second guessing and uncertainty. Please recognize that family members may be right but they are not eyelid experts. Surgical results that initially look rough because of swelling and bruising, often settle down and look remarkably better with time to heal. There are rare, immediate eye health concern, and these should prompt immediate attention from your surgeon. These included increasing pain, swelling, redness, and bruising, or changes in vision. When these occur in hours or days after eyelid surgery they can represent vision threatening issues such as bleeding behind the eye or infection. Immediate care by your surgeon is essential. If you are having this type of an issue and your surgeon is not immediately available, it is advisable to be seen in an emergency room where the emergency care of an ophthalmologist or plastic surgeon can be arranged.
Another set of urgent post-operative issues include difficulty opening or closing the eyelids, double vision, or other restrictions in eye or eyelid movement. Right after surgery, local anesthesia can account for some of these types of issues, but after 24 hours, the presence of this type of an issue, suggests a mechanical problem created by the surgery. In some cases, these issues require urgent surgical exploration. In all cases, you should be seen by your surgeon to assess what is going on. Recognize that non-eyelid surgery specialists often perform eyelid surgery. These surgeons lack the ability, skill, training, and equipment to properly examine your eye. Eye pain and light sensitivity can be caused by a corneal abrasion, corneal ulcer, or intraocular inflammation. Without a slit lamp and the necessary training, your surgeon cannot diagnosis these issues. Immediate consultation with an oculoplastic surgeon or general ophthalmologist may be necessary.
Once you get about a week out from surgery, the issues tend to be related to eyelid shape, surgical symmetry, visible scars, and eyelid malposition. Generally, these types of issues get better with time. However, problems that can persist are evident even this early after surgery. It can be difficult to determine which issues will settle down and resolve on their own to your personal satisfaction. It is important to discuss your concerns with your surgeon. Surgeons will sometimes attempt to minimize your concerns. This may be appropriate. It often comes down to a level of trust. If you feel like your trust and confidence in your surgeon is being abused, that is a significant warning sign. Patients are not often wrong. If you have a concern, your surgeon should also be able to see it and explain to you why or why it is not a concern, and what will need to be done about it. It may be as simple as “we will watch this.” When your feelings are not validated or your feel you are not being told the truth, there is often a break-down in the doctor-patient relationship. This is when a second opinion can be helpful.
It you have healed and surgery is in the past, this does not mean you have no options. A detailed personal consultation can establish precisely what is causing your issues and how best to correct the problems. This type of work requires considerable maturity and experience. It is often necessary to have unique solutions tailored to you personal situation. A cookie-cutter approach is not going to do it. Dr. Steinsapir takes the necessary time to define your problems and the best approach needed to help you achieve your goals.
Dr. Steinsapir provides attentive, comprehensive care to ensure you achieve the results you desire, and he always designs your care on an individual basis, making himself available to answer all your questions so you can feel confident both before and after treatment. He can take over your post-operative care if necessary or coordinate with your surgeon to provide input and suggestions to help speed your recovery. To learn more about fixing eyelid surgery, please call today to schedule a consultation with Dr. Steinsapir.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.
My lower eyelid is sagging after eyelid surgery-what should I do?
First take a deep breath. Things happen after eyelid surgery. Many things fix themselves with a little time. Before surgery, your surgeon went through a lengthy list of things that might happen with surgery. Of course it is human nature to think that none of that will happen to you. In some cases I think that the surgeon sends a subliminal message that even though all this stuff is in the consent, it is a mere formality. Having an issue after surgery is an unwelcome shock. If you trust your surgeon, that confidence should help get you through the rough patches after surgery.
There can be a number of reasons for why the lower eyelid sags after surgery. In some cases swelling can push the lower eyelid away from the eye. This can occur in conjunction with a process called chemosis. Chemosis is the medical term for swelling of the white of the eye or the conjunctiva. Just as the eyelid will swell after surgery, the conjunctiva can swell. When it is swollen, the conjunctiva has been described to look like “jelly.” The best treatment for this is ocular lubrication and time. This often resolves with tincture of time.
Another cause of lower eyelid sagging is preexisting laxity of the lower eyelid. Swelling after surgery causes the laxity to be exaggerated resulting in the unsatisfactory position of the eyelid. In many cases again time is the best treatment.
When the surgeon cuts the skin of the lower eyelid to remove “extra lower eyelid skin,” malposition of the lower eyelid can be more serious. Under these circumstances the lower eyelid can be short of skin or the muscle that helps hold the lower eyelid against the eye can actually be damaged by the surgery. Rather than allowing this to heal, surgeons often feel the need to provide an early fix. That early fix can help resolve the issue or make it worse.
Generally, due to mechanical issues, some of the simple treatments can actually be helpful. These include steroid injection, mechanical finger winking, and when appropriate a pull up suture placed to support the eyelid corner for a few weeks. When these measures fail, it is best to let the eyelid heal before attempting revisional surgery. So often Dr. Steinsapir is called in to fix an eyelid where the original surgeon has made several well meaning attempts to “tuck up” the eyelid early after the original surgery with each procedure making the situation worse.
What will your eyelid need? It often depends on precisely what factors are contributing to the circumstance. If your surgeon was not a fellowship trained oculoplastic surgeon, it is often helpful to see someone who is. The additional training and experience may be precisely what is needed to address the situation.
About Dr. Steinsapir
Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.
Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a
