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Lower Eyelid Retraction:Revision Surgery
I had transcutaneous lower blepharoplasty 11 months ago.
No skin was taken, just fat removed and rearranged.
I have scarring in the lower right eyelid that is pulling down my eyelid (1 mm scheral show).
The original surgeon wants to do a revision by re-opening the incision half way and "easing the scar tissue of the underlying" muscle.
So, the incision would once again be transcutaneous.
Does this sound like it is the proper surgery?
I am worried that more scar tissue will form and that the lid will once again be retracted.
Or, he will cause damage to the underlying muscle.
Any advice would be great,
Seek additional opinions is the first step. If you are satisfied the original surgeon's plan will agree with the other in person opinions than go a head. I can only guess, but I would do an internal release + a lateral canthopexy.
Treatment of lower eyelid retraction is very difficult.
In our practice, we usually perform an ultrashort incision cheeklift (USIC) and rearrange the canthus for mild cases. For more severe cases, canthotomy with canthoplasty is necessary. For even more severe cases, grafting becomes necessary. The results get progressively less satisfactory as the severity of the lower eyelid problem becomes more severe.
It is important to recognize that even in the best hands in the world, and I have seen those results, this is a difficult problem and patients are not going to get their pre-surgery eyes back in many cases.
This is disheartening to hear but patients must have a realistic expectation of their likely outcome. In many cases, the result is a subtle improvement, but not perfection.
Therefore for patients with a lower eyelid problem, it is best to seek advice from surgeons skilled with lower eyelid revisional surgery and cheeklift / midface surgery, the key in my opinion to a successful result.
I think your original surgeon needs to rack up more "CME" credits (Continued Medical Education that PSs get when attending ASAPS seminars).
For example if he approached the fat compartment from the outside of the lid (transcutaneous) as in selected an incision outside the lid exclusively to remove and rearrange fat, it would perhaps, imply, he did not have a good appreciation of the "orbital septum"; an area actually violated when approached from front as to 'get at' the fat behind it. Violation of that area is associated with scarring that does pull down the lid. Doctors who advise AGAINST approaching the fat compartments through that route, note that the orbital septum is an "unforgiving area" and advise in FAVOR of approaching the fat compartments from behind the orbital septum which involves an incision INSIDE the lid---transconjuntival approach to fat compartments.
Given your doc's original approach to accessing the fat compartments, I'd say you have good reason to worry about your docs proposal to 'fix it'.
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