LEARN, SHOP & CHAT ABOUT PLASTIC SURGERY, BEAUTY AND ANTI-AGING





Mehryar (Ray) Taban, MD
Expert Profile



User Photo For: mytaban
Mehryar (Ray) Taban, MD
Oculoplastic surgeon | Views: 53107


Friendname: mytaban
Business Name: TabanMD
Website: www.TabanMD.com
 
Location: 435 N Roxbury Dr, #104
Beverly Hills, CA 90210
United States
Telephone: 310-278-1839
Languages Spoken: English




Post a reply Ask Mehryar (Ray) Taban a question Return to Mehryar (Ray) Taban's homepage



Ask An Expert > Mehryar (Ray) Taban Message Board > PLEASE HELP! Unable to Repair Ectropin
AUTHOR MESSAGE
Default User Photo
Stressed
,
PLEASE HELP! Unable to Repair Ectropin
I am currently in a horribly dire position
I have a case of what appears to be uncorrectable ectropin. I have a genetic blindness and now in the final stages of vision loss which I feel is being hastened by my eyes somewhat weakened function and currently unrepairable condition. So I am in an extremely desperate position and seek assistance from anyone who feels they may have any information that may help or know anyone who may. Thank you for any efforts.
As seen the the photo, this ectropin doesn?t appear to solely pull downward but outward as well, leaving the eyelid corners to be pulled away from the eyeball even in the better eye.
On returning the lower eyelid to its correct position with my finger, it would appear to be just enough surface tissue to do so without it forming stretch marks (barely).
Immediately after the operation until now the sensation Ive noted that has changed from before the surgery include
1) a slightly tight or pulling sensation in the furtherest corners of the eyes away from the nose in an outward/downward direction,
2) the lower eyelid itself only in this furtherest outer section feels shorter than before.
3) the skin on the surface feels looser than the inner skin in the outer corners of the eye and it doesn?t sit molded against the orbital bone anymore
The corrective doctor is unsure why its repair hasn?t worked successfully. Even more so that even in the eye that has improved considerably after this corrective procedure, how he is going to allow the furtherest corner of the eye to return to touching the eyeball as you cant pull it toward the eyeball via any means he is aware of as there is no way to anchor it. (you cant see this very well in the pictures)
Also after the corrective procedure new folds of skin have appeared on the upper eyelid that weren?t there before. Prior to this however I was advised there was not enough upper eyelid skin to perform a graft, if that ends up being the only solution (trying to avoid this due to believing it will look bad/obvious and skin wont match)

Corrective doctors notes
?Five years ago the patient had a lower blepharoplasty in Thailand which he was mostly happy with but he developed a fold in the left lower lid and the Thai surgeon said they could fix it and also improve his crows feet while doing an extended upper/lower blepharoplasty. He noticed immediately after that surgery that he had quite marked scleral show and ectropion and advised him that it would settle down. We initially injected mixtures of Triamcinolone and 5 Flurouracil. This did result in some softening and mild improvement in position.
Op notes 27/2 2012 -
TECHNIQUE
Ltaeral cantholysis/subciliary incision - subperiosteal disection and from intraoral. Infraorbital nerve preserved - bruised/stretched more on Right.
Lateral cathal tightening to periosteum with 5.0 vicryl. Reconstruct canthus 6.0 fast gut. Midface lifted onto periosteal flap with 4.0 safil on R , 4.o Dragofil on Left. Orbicularis to periosteal flap 5.0 monoplus. Eyes fully closed now.
2.0 disolving barbed sutures (HappyLift) to temporalis fascia.
2.0 Frost sutures over tape bilaterally. Close intraoral 4.0 safil

Improved but not fully.
Trialled Hyaluronic Acid gel filler to add support - but not improved and slightly full.
The patient says it still feels tight and feels better by pushing the lower lid lateral canthus medially.
We have considered an internal spacer.?

I have attached photos showing the eyes after the original operation that caused the problem and more of its current condition at this point in time. It has been some five months since this corrective operation. I have been massaging the eyelid upward as best as possible as requested and there appears to be little scar tissue formed (none requiring release) after the corrective attempt (and little bruising after the operation).
I desperately need to find a way to repair it fully on the next surgery or risk losing the remainder of my vision while in this condition. For if the repair doesn?t work and Id have to wait a further six months or so for reoperation and Im unsure if my remaining vision could endure it.
Thank you so much for your help.
Regards,
Simon



Attached Media

Photo:

After Thailand Operation

Photo:

4 months After Corrective Proceedure

Photo:

4 months Looking Upward




samir
Plastic surgeon
Baltimore, MD
United States
View My Professional Profile
Ectropion  July 9, 2012 11:31 AM

You have a serious vision problem and you say you are loosing your eye sight.
You also have post surgical ectropion surgery done in thailand. Failed correction now.
You need to be seen in a major university center of ophthalmology.
Try the WILMER INSTITUTE at johns Hopkins University


docpichler
Plastic surgeon
sacramento, CA
United States
View My Professional Profile
Ectropion  July 9, 2012 11:40 AM

Your problem is severe but definitely correctable. I basically agree with the previous comment. You need to be seen by en experienced oculoplastic surgeon at a major university medical center.


stressed
PLEASE HELP! Unable to Repair Ectropin  July 9, 2012 12:55 PM

Thanks for your responses. I will be approaching someone with high standing. I have learnt with medical matters as serious as this to try consult with as many as possible to get a more well rounded and researched opinion. However it is difficult in the position Im in, except via the internet.


mytaban
Oculoplastic surgeon
Beverly Hills, CA
United States
View My Professional Profile
lower eyelid ectropion/retraction  July 9, 2012 2:19 PM

Hi. Unfortunately, your problem is not uncommon. Your lower eyelids are pulled down, from both tight cheek/lower lid skin and weak orbicularis muscle responsible for closing the eyes. Reconstructive surgery is possible. Please see an oculoplastic surgeon.
www.TabanMD.com


stressed
  July 11, 2012 10:49 AM

I will of course be going to see someone with experience. But can anyone please tell me what they think likely correction procedure may be?




 



 

Welcome to the Ask An Expert section of our website! Our network of board certified physicians can answer any questions that you may have regarding plastic surgery, skin care, dermatology and other conditions. Popular topics include tummy tuck, liposuction, rhinoplasty, acne scars, facelift, breast augmentation and more. This frequently asked questions section is opened to everyone and you need to set up an account with Makemeheal before you can ask your own question. This service is absolutely free and is available to those who are interested in learning more about a particular cosmetic procedure, treatment or product.

Before asking a question, we recommend you to browse through our existing collection of questions and answers to ensure that the question you want to ask have not already been answered by our highly experienced experts. This will help you save time and get an answer more quickly. When asking a new question, we recommend you to be very detailed so that our experts could formulate a more precise & professional answer.

Of course, this service is not a substitute for a doctor visit or a consultation with a plastic surgeon or cosmetic dermatologist. The answer you will find here only serve as initial directions of thoughts and not as specific instructions. You should remember that it is utterly important to consult a skilled specialist prior to scheduling any type of treatment in order to get acquainted with possible contraindications. Only a one-on-one meeting will enable your cosmetic surgeon to properly evaluate your condition, conduct examinations and explain their results.