How Eyelids that Can’t Fully Close after Cosmetic Surgery are Revised, and Avoiding Skin Shortages

How Eyelids that Can’t Fully Close after Cosmetic Surgery are Revised, and Avoiding Skin Shortages

my eyes can’t close fully after eyelid
surgery what can I do cosmetic eyelid surgery is a delicate and precise
procedure where the difference between an outstanding result and a complication
such as eyelids unable to close properly can be measured in millimeters eyelid
surgery ranks typically at about number three in the top five cosmetic surgery
procedures year after year this means in general plastic surgeons as well as non
surgeons offer cosmetic eyelid surgery however when it comes to revising
complications after cosmetic eyelid surgery such as the eyes not properly
closing the specialist of choice is a Fellowship-trained oculoplastic surgeon
I’ll explain how I approach complications from eyelid surgery for
people who come to me from around the world in my practice I’m Dr. Amiya
Prasad I’m a board-certified cosmetic surgeon and fellowship trained
oculofacial plastic and reconstructive surgeon I’ve been in practice in
Manhattan and Long Island for over 20 years as a cosmetic oculofacial plastic
surgeon I regularly perform primary cosmetic upper and lower eyelid surgery
as well as revision and reconstructive surgery for the eyelids an important
complication associated with upper eyelid surgery occurs due to skin
shortage after surgery in cosmetic upper eyelid surgery redundant or excess
eyelid skin is carefully measured and excised to address eyelid hooding
additionally fat can be sculpted to improve the shape and appearance of the
eyes when too much eyelid skin is removed during surgery this can result
in having a serious effect on eye health with the eyelid not
being able to properly close another cause for eyelid skin shortage occurs
when eyelid skin is removed without addressing eyelid ptosis eyelid ptosis
is a condition where the upper eyelid is lower than it should be which makes you
look and often feel tired this drooping of the eyelid is
associated with the function of a muscle which lifts the eyelid called the
levator muscle eyelid ptosis surgery requires extensive knowledge and
experience that is not part of any other surgical training other than
oculoplastic surgery in order to train as an oculoplastic surgeon you need to
first train in ophthalmology or eye surgery I find that general plastic
surgeons often don’t recognize ptosis and remove upper eyelid skin for
cosmetic enhancement even if there is very little skin to remove in these
cases eyelid skin is removed but the island still droops since the ptosis
wasn’t treated there can also be a shortage of eyelid skin at the same time
with lower eyelid surgery a skin shortage can also be an issue
when lower eyelid skin is excised doctors often remove lower eyelid skin
thinking redundant skin is causing wrinkles this is often done during
surgery to address the under-eye bags called lower eyelid blepharoplasty since
facial aging is significantly caused by bone loss particularly around the eyes
and cheeks the skin can appear to sag in addition age sun exposure and other
health related issues affect skin quality which results in skin wrinkling
skin quality can be treated without removing skin the lower eyelid position
depends on a delicate balance of the skin muscle and tendons
when surgeries such as transcutaneous blepharoplasty is performed by making an
below the eyelashes and having skin removed this delicate balance is at risk
of being compromised a skin shortage of the lower eyelid can
result in conditions such as lower eyelid retraction and lower eyelid
ectropion I routinely perform lower eyelid surgery by addressing the puffy
under eye bags from the inside of the eyelids using a technique called
transconjunctival blepharoplasty which preserves this delicate balance at the
same time I treat wrinkles with different types of lasers and
radiofrequency technology combined with regenerative medicine technology such as
PRP or platelet-rich plasma if there is a fold of skin that is overlapping I’ll
perform a limited skin pinch type of excision coming from a background in
ophthalmology I always emphasize to my patients the importance of optimal
eyelid function for proper eye health for example the simple action of normal
blinking is critical because the eyelids function like windshield wipers to
distribute your tears evenly over the front surface of your eyes proper
lubrication of the cornea which is the clear part of the eye you see through is
necessary for optimal vision people with an eyelid skin shortage complain of
having irritation such as a foreign body sensation and dry eyes because the
eyelids can’t function properly to lubricate the surface of the eye
patients with upper or lower eyelid skin shortage report that sleep is difficult
because the eyes don’t fully close leaving a gap resulting in irritation
mucous production and blurred vision no surgeon is immune to dealing with
complications or unanticipated outcomes however the optimal management of
complications is critical much of eyelid surgery issues such as
skin shortage retraction or undiagnosed ptosis can be managed through the basic
principle of restoring anatomy for optimal appearance and function I find
that a lot of patients who come in for revision eyelid surgery underwent
several attempts by the original surgeon to improve the patient’s condition with
ineffective surgical procedures which often makes things worse when evaluating
a patient with difficulty with our closure I look first at the immediate
management of the eye itself to ensure preservation of vision and eye function
I look at specific anatomic deficiencies such as skin shortage or internal tissue
scarring I determine if it makes sense to wait and allow for tissue relaxation
to potentially improve the patient’s eye closure without surgical intervention if
there is a significant upper eyelid skin shortage an option is to do a skin graft
in the lower eyelids the balance of anatomic components were compromised
often requires procedures such as skin graft lower eyelid support graft and the
repair of a canthal tendon or the attendant supporting the eyelid in cases
where eyelid ptosis was not addressed at the time of surgery I approach this
problem through ptosis surgery procedures such as levator muscle
advancement or from behind the eyelid with a technique called conjunctiva
Muellerectomy I typically perform a revision eyelid surgery in my private
office surgical facilities I also performed a surgery with local
anesthesia and LITE IV sedation people coming for revision eyelid surgery are
often quite relieved that they aren’t going through general anesthesia again
although complications can occur with any procedure I exposure and the
potential for compromising vision makes the outcomes of primary eyelid surgery
and revision eyelid surgery more than just about appearance restoration of
function appearance and character to your eyes is possible in most situations
should you experience a problem after undergoing eyelid surgery I hope you
found this information helpful thank you for your question

About the Author: Earl Hamill


  1. Hello doctor,
    I hope you're doing well and great.
    I'm Aryan 21y from UAE, for a month I'm using phytolium 4 alongside with Minoxidil 5% & Zincnovit tablet,
    and I have gone through PRP 1 session and mesotherapy 4 sessions,
    So doctor, continuing all of these drugs as a routine okay for me or not?

    Thank you,

  2. Hello Dr. Prasad,,
    I've lost 35 KGs in my losing weight journey. And I've so much sagging and loose skin plus stretch marks almost everywhere.. what can you advice me to remove those two main problems?
    I'm 31y

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