Secondary lower-eyelid surgery

Abstract

David W. Furnas, MD David M. Metzner, MD Nicholas Taylor Iliff, MD Francis G. Wolfort, MD Dr. Furnas: The first patient is a 60-year-old woman who had a bilateral upper and lower bleph-aroplasty 20 years ago (Figure 1). Postoperatively, the left lower lid was too low and she went back to the same surgeon who operated on the right side. Figure 1. This 60-year-old woman had bilateral upper and lower blepharoplasties 20 years ago. She complains of tearing, irritation, and scleral show of both eyelids, particularly the right Now she is complaining of tearing and irritation in both eyes. Of particular concern to her is that her mascara runs. She complains of having to keep her head down to hide this when she is photographed. Dr. Metzner, how would you analyze this problem? Dr. Metzner: Her eyes are irritated and tearing because they are drying; it is just evaporation. She is getting reflex tears produced by the lacrimal gland. I see lower-lid retraction and scleral show. She has a desirable upward slant from the medial to the lateral canthus. She has skeletonization of both lower orbital rims. May I assume she has also had a face lift? Dr. Furnas: Yes, several. Dr. Metzner: She seems to have upper-eyelid ptosis, worse on the right than the left, and a high supratarsal fold, which I know is not our subject. But it may be that, for overall aesthetics, if you are successful in getting the lower lids up, you may also want to correct the ptosis so that the palpebral fissure is not too narrow. I hope that she has not had a midface lift because I think that a midface lift might be the best way to deliver, by mobilization, more soft tissue to the lower eyelids, take the weight off of them, …