Complications following a midface lift are especially disconcerting because they can affect the basic functions of your eyes. Whether your eyes begin to droop, tear, or fail to blink, any change in the way your eyes and face function is reason enough to contact your doctor. But sometimes, surgeons panic in these situations and respond with a fix-it mentality and may be encouraging you to undergo corrective surgery immediately. Your surgeon may just want to take care of the problem as quickly as possible and as a result, you may be receiving mixed messages from your physician about the best course of action. However, immediately following your facelift may not actually be the right time to fix the problem.
Undergo a consultation
Before taking any action to correct your midface lift complications, carefully weigh your confidence in your current surgeon. There is no substitute for an in-depth personal consultation because discussing your problem with your doctor over the phone doesn’t allow him or her to see and fully understand the physical issues. Occasionally, the description of what is going on and the actual physical complications are not the same.
If you are not 100 percent confident in your surgeon and are casting about for opinions from strangers, listen to your feelings. Do not blindly follow the recommendations your original surgeon or any surgeon if their recommendations do not make sense to you. While you may not like your appearance and may be experiencing profound disappointment, these issues are seldom a medical emergency. Don’t commit to a second surgery unless you have a clear understanding of the following:
- what is going on and why these complications are occurring,
- what type of surgery your doctor has planned,
- why a surgical solution is necessary at this time,
- the risks of a second surgery, and
- the probability of success or failure.
The risks of midface and lower eyelid surgery and corrective surgery
Lower eyelid surgery and midface surgery have significant risks associated with them. Your surgeon may not fully understand these risks. If you’re experiencing complications it does not mean that your surgeon did anything below the standard of care. However, how your surgeon addresses the problem can make a profound difference and he or she should not rush the process.
The anatomy described in some of the most important and most recent papers in the field of lower eyelid and midface surgery done through a skin incision under the lower eyelashes (infracillary incision) is inaccurate. Dr. Steinsapir recently reviewed the literature on this subject and presented it before the Fall 2010 American Society for Ophthalmic Plastic and Reconstructive Surgery Scientific Symposium. Some of the core papers describe anatomic hypotheses rather than proven anatomic fact. For example, the soft tissue of the cheek is mobile (i.e. it slides when we smile), and the lower cheek is also mobile over the lower half of the face. In this location, the nerves responsible for facial expressions around the mouth travel in such a way that it is possible to safely dissect this plane in the lateral half of the lower face; this is a key aspect to the so-called deep plane facelift.
Similarly, surgeons dissect under the skin and lower eyelid muscle to perform midface lifts. Published papers appear to support the hypothesis that this midface lift technique can be performed without injuring the nerves that feed the eyelids. Unfortunately, a hypothesis is a scientific guess, it does not make an established anatomic fact. There is also clear evidence in published papers suggesting that the nerves that supply the lower eyelid orbicularis oculi muscle travel in this so-called glide plane, which is actually just somewhat mobile fat and loose connective tissue between the cheek bone and the orbicularis oculi muscle.
So why do doctor’s still perform this kind of surgery despite the risks? Despite the inaccurate papers, it is possible to dissect in this plane without significantly altering the nerve supply to the orbicularis oculi muscle in some individuals. Yet others may not do well. This may have to do with how aggressive the surgeon is and the exact nature of the distribution of these motor nerves, which do vary somewhat from person to person. Additionally, when this dissection is carried out laterally into the crowsfeet area, it is also possible to do significant damage to the nerves that provide innervation to the orbicularis oculi muscle in the upper eyelid as well. This is significant because the elements of the orbicularis oculi muscle near the lower eyelid margin are responsible for blinking the eye closed. Without this critical blink function, tears are not moved across the corneal surface properly resulting in dry eye and tearing issues. When the lower eyelid slumps, it does not properly cover the lower portion of the eye and there is increased corneal drying.
The remedy for midface and lower eyelid surgery complications
To address eyelid complications from a midface lift or lower lid surgery, the best answer is to avoid further eyelid tightening and allow the tissues to heal. In six months or more come back and address the situation with your surgeon if problems persist. By preserving as much of the lower eyelid and not cutting out tissue―as would be the case if your doctor were to try to fix the problems immediately following your initial surgery using a technique called canthoplasty―there are many more options and increased likelihood of an improved outcome if you allow the tissue to heal. While in the healing process, keep lines of communication open with your surgeon or look for oculoplastic surgeons for consultation who have as a focus of their practice the repair of unsatisfactory cosmetic eyelid surgery. Be skeptical of solutions that must be done “urgently” or don’t make sense. While very few of these complications mend themselves, with time it may improve so that less work may be needed than first thought.
About Dr. Steinsapir
Dr. Steinsapir trained alongside the inventor of BOTOX and has performed thousands of BOTOX treatments in Los Angeles since 1988 and recently patented his Microdroplet BOTOX technique. He is a board certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Southern California 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. 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 treatment is right for you.
