Ask Dr. Barber

Q. About a year ago, I had an upper eyelid lift by a plastic surgeon outside of Greensboro. Everything seemed to have gone well after surgery except that I am still not able to completely close my eyelids together. There is a gap between each upper and lower eyelid when they are supposedly closed. I really cannot see the gap myself, but my husband says it is very noticeable when I am asleep. In addition, my eyes are always dry, and I am constantly having to use drops to moisten them. My plastic surgeon says that it will eventually get better and that there is nothing that needs to be done about the issue. Is there anything that I can do to help this problem?

A. The condition that you are describing is called lagophthalmos, and is a known risk of performing an upper eyelid blepharoplasty. This condition is a complication related to over resection of the upper eyelid skin. This over resection makes the upper eyelid too tight, resulting in the inability to completely close the eyes. The most common indication for an upper eyelid lift is because there is excess eyelid skin, which makes the upper eyelids look heavy and tired. In the worst cases, the upper eyelid skin can interfere with peripheral vision. An upper eyelid blepharoplasty is designed to remove most of the excess skin. One of the most important steps in doing upper eyelid surgery is to accurately measure the amount of skin that needs to be removed, removing only the redundant skin and nothing more. If the measurement is not accurate or if the amount of skin removed is not consistent with the measurement, then either too much skin is removed, or not enough. In eyelid surgery, since accuracy needs to be to the millimeter, it is best to measure twice (or more), and cut once. It is also much better to be conservative when removing the eyelid skin, because it is much easier to go back at another date to remove a little more skin than it is to correct the issue with which you are currently suffering. 

So, to get to your question about what can be done to improve your situation. The first step is to try to stretch the upper eyelid skin in a downward direction. This is a simple maneuver, where you put a couple of fingers over your closed upper eyelid and pull the lid downward. Hold it for about ten seconds and repeat several times. Perform this exercise at least 10 times a day. If after 6-12 months of performing this maneuver it does not solve the problem, then I am afraid that surgery will be the next step. The corrective surgery is designed to graft some skin, usually harvested from behind you ear (best skin color match), onto your upper eyelid to add additional skin to the lid. The additional skin relaxes the tightness. This procedure is not complicated, but it may take many months afterward to correct the problem of not being able to completely close your eyes. I would recommend that you revisit your plastic surgeon, since it has been a year now, and see if he/she can help you. If not, I recommend you see another board certified plastic surgeon or an oculoplastic surgeon about the problem. Good luck.

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