Fixing Prior Blepharoplasty (Eyelid) Surgery
If you’ve done your research and chosen a reputable doctor who specializes in oculofacial plastic surgery, chances are you will achieve satisfying results. While it is accurate that you needn’t fear surgery performed by a top-rated practitioner, it is also true that sometimes there are complications, and if you are the unlucky one experiencing complications, you need help soon.
The best doctors know not only how to give you great surgery results – they also know how to correct complications should they arise. Occasionally complications may arise from surgery, which require correction beyond the skill of the original surgeon, or the doctor-patient relationship may break down, and this is when you need to seek a second opinion. Fortunately, these circumstances are unusual.
Do I need help right away?
Many people are naturally worried about how their surgery will heal when in reality things will be just fine. This is the case with most anxious patients, as we discussed in a recent post. However, everyone must admit that sometimes something can go wrong, as with any medical procedure and even in any professional field. It is important to understand that these are the times when you need your surgeon the most. Do not wait for your next appointment. Call your surgeon. If you feel you are having a true emergency, go to an emergency room or call 911. Someone can call your surgeon later to let he/she know what is going on. It is far better to be seen for something that turns out not to be serious than to miss something important. An expert physician must understand how to respond in such unusual situations, and fortunately such doctors are available. The key is handling the situation gracefully, swiftly, and effectively.
After blepharoplasty surgery, these conditions are not normal:
1. Bleeding. Generally any bleeding should cause concern. While it does not take much blood to look like a lot, it is not normal to have any visible bleeding after surgery. It can be caused by a number of reasons, most commonly activity after surgery. If you are experiencing this, call your surgeon, discuss the situation and follow their directions.
2. An expanding bruise in the eyelids. This is generally a sign that you are bleeding inside the eyelid where surgery was performed. Again this is rare but needs prompt attention. Call your surgeon immediately. If you have any trouble reaching the surgeon, go to an emergency room especially if there is pain and changes in vision.
3. Pain that is not relived by the pain medications prescribed for use after surgery. The most common reason this might happen is deciding that you really don’t need to take the pain medicine after surgery. Then hours later, everything wears off and not surprisingly you hurt. At this point, it can literally take two hours for oral pain medicine to return you to a pain free state. While the truth is that many patients truly are comfortable after surgery without medications but not ever one. This is perhaps one of the more common reasons for patients to call after surgery. However, there are situations after surgery where pain breaks through even on the prescribed medications or days after surgery when there should not be any pain. Pain is a very important sign. It might represent a lack of pain medicine right after surgery, an expanding bruise, or days later, the earliest symptoms of an infection. Share your concerns with your surgeon and pick up the phone.
4. Loss of vision. Bleeding behind the eyes can cause permanent loss of vision. This is uncommon, estimated to occur 1 in 300,000 eyelid cases. Prompt steps can save the vision. But immediate attention in necessary. Call your surgeon immediately or 911.
5. New onset pain, swelling, and redness in the area of surgery two or more days after surgery. These can be signs of an early infection. Again, don’t wait for your next visit. Call your surgeon to discuss the situation.
Concerns that are significant but not as urgent
It’s normal to experience some bruising and swelling during the healing process, but in rare instances this can be severe to affect the outcome. Severe bruising can lead to excessive swelling, which can stretch the eyelid as it heals and alter the final results. Your doctor can help you understand what sort of bruising is expected and what is excessive.
If your eyes look droopy or heavy after surgery, you are experiencing one of the more common complications of surgery called ptosis or blepharoptosis that occurs when the upper eyelid tendon slips. This can happen if it is cut during surgery, but can sometimes happen on its own, and the effect is intensified by severe swelling. It is very common for the upper eyelids to be heavy after surgery due to swelling. This does not mean that your surgery is a failure. Most commonly this heaviness does resolve over a several week period allowing the lid to return to its proper height with no intervention. In some cases, it may take quite a while for the swelling to resolve. For this reason it is generally a good idea to simply give the eyelid time to heal. Should the heaviness fail to resolve in a 6 to 12 months time frame, corrective surgery is appropriate. Although you may only notice heaviness in one eye, reconstructive surgery on both eyes may be necessary. The eye plastic surgeon will closely evaluate you for a subtle ptosis of the other eye to determine the best method of correcting the eyelids.
Some cosmetic surgery textbooks instruct students of medicine to place the upper eyelid crease too high, and through no fault of their own some new professionals may erroneously follow this advice that they only could have known to avoid through increased experience. It is generally easy to raise a crease, but one made too high can be difficult to lower, and requires the most careful and most experienced of care to resolve through further surgery. It’s best to avoid this situation by finding a doctor who understands that the crease is commonly placed to high, but if you’re reading this now because it’s already too late and you’re unhappy with your surgery, then it’s a good idea to seek the opinion of another doctor who can discuss with you the best action to take next.
Other complications that may arise are having loose skin that does not hold makeup, or having eyelashes that droop downward. These issues can be resolved by properly tensioning the skin and adjusting how much skin is present. This procedure is called anchor blepharoplasty and can be performed under local anesthesia in the office setting. Sometimes, the eyebrows seem to fall after upper eyelid surgery. When you are told about the possibility before surgery, this is an expected effect. The result may be satisfactory or a forehead lift may be needed to reposition the eyebrows. It is post-operative surprises that can erode confidence in your surgeon. An experienced surgery anticipates these types of issues and informs you about them ahead of time. He or she can help you decide if a forehead treatment instead of or in conjunction with additional eyelid surgery is necessary.
It is far easier to correct an underdone cosmetic surgery than undo an overaggressive surgery. One does not need to be made drum tight to have a great surgical result. Think about it, when was the last time you saw a model look like they had stuck their head in a wind tunnel? By optimizing the surgical plan it is possible to have extremely natural results that give no indication that they were achieved by cosmetic surgery.
If your friends and loved ones think you look worse, or you just aren’t happy with your results, or you lack confidence in your current physician, you should seek a second opinion from someone who specializes in correcting previous surgeries. At best the doctor can assure you that things are going fine or repair your relationship with your former surgeon. If early action must be taken to correct a problem, a consultation with another doctor can help you decide what to do.