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Correcting the Eyelid through Revision Surgery

One of Dr. Zoumalan’s specialties is correcting abnormal eyelid positions. The term revisional eyelid surgery refers to the correction of the eyelid position (either upper or lower lid) after having undergone prior eyelid surgery. Two of the more common reasons patients see us for eyelid malpositions after undergoing prior blepharoplasty or eyelid reconstruction from trauma or removal of an eyelid skin cancer.

The eyelid is a series of complex aesthetic units that, all together, make it an extremely challenging area to operate on. It is difficult to tell which patient is at risk for having an eyelid malposition prior to any surgery but in many cases, your plastic surgeon does his or her best in preventing such circumstances.

“My goal in revisional eyelid surgery is to customize the management to each patient. Conservative therapy can often help in some symptoms, but ultimately a fair number of patients will end up requiring some form of revisional eyelid surgery. The healing process from prior eyelid surgery can last up to a year or so and it is important to receive care from an eyelid specialist as early as possible in such instances in order to manage the healing process toward an optimal direction. Non- surgical measures such as steroid injections, lid massages, sutures to keep the lid on stretch, hyaluronic acid fillers are some measures that may be required in the postoperative healing phases to help control and direct the eyelid to heal as best as possible.”
– Dr. Christopher Zoumalan, MD FACS

Once you and the doctor believe that the eyelid changes have been stable and require revision, surgery may be warranted. There are various components to performing revisional eyelid surgery and it depends on each patient’s clinical findings. Dr. Zoumalan will examine you and review your surgical history. And after reviewing your old photographs, he will devise a surgical plan that best fits you.

Upper Lid Revision:

Upper lid malpositions can result from prior blepharoplasty which results in excessive skin removal and subsequent difficulty closing eyelids (termed lagophthalmos) and dry eyes. There are various ways of addressing and treating this problem. Dr. Zoumalan needs to examine you and recommend the best treatment plan for you depending on your examination findings and symptoms. Furthermore, prior ptosis surgery (droopy lid surgery) can result in asymmetry (either in lid position or the shape of the lid). Although these can often be complex in repair, Dr. Zoumalan has had experience in addressing upper lid asymmetries from prior surgery.

Lower Lid Surgery:

Oftentimes, in cases of lower lid revisional surgery, the lid may need some form of resuspension after the scar tissue planes are released. In order to address the shortage of skin that may be present, a midface resuspension with the in incorporation of a posterior graft (such as a hard palate graft) can result in an optimal result while avoiding the need for a skin graft altogether. The surgery typically takes 2-3 hours depending on the complexity of the case and you can expect to go home the same day of surgery. Bruising is minimized by Dr. Zoumalan’s rapid recovery techniques but patients should expect to be swollen for at least 2 weeks.

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    Preoperative Diagnosis: Bilateral upper lid ptosis and right lower lid retraction

    Procedure performed: Bilateral upper lid ptosis surgery and right lower lid retraction repair through a canthoplasty lid resuspension technique and posterior spacer tissue graft.

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    Preoperative Diagnosis: Right lower lid retraction from prior trauma

    Procedure performed: Right lower lid retraction repair using an Alloderm spacer graft with a canthopexy.

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    Preoperative Diagnosis: Bilateral lower lid retractions and ectropions (outward everted lids) from prior surgery and chronic sun damage.

    Procedure performed: Bilateral lower lid retraction repair using an Alloderm spacer graft with a canthoplasty (lid resuspension and tightening).

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    Preoperative Diagnosis: Right lower lid retraction

    Procedure performed: Right lower lid retraction using a tissue graft and canthoplasty

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    Preoperative Diagnosis: Lower lid retraction

    Procedure performed: Lower lid retraction using a hard palate graft, canthoplasty, and midface lift

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    Preoperative Diagnosis: Bilateral lower lid retraction

    Procedure performed: Bilateral lower lid retraction repair using a hard palate graft and canthoplasty.

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    Preoperative Diagnosis: Bilateral upper lid ptosis and lower lid retraction

    Procedure performed: Bilateral upper lid ptosis surgery and lower lid retraction repair through a canthoplasty lid resuspension technique.

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    Preoperative diagnosis: Bilateral upper lid ptosis, lower lid retraction, lower lid excess fat pockets.

    Procedure performed: Bilateral upper lid ptosis repair,revisional lower lid retraction repair using Alloderm graft and canthoplasty, and lower lid blepharoplasty.

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    Preoperative diagnosis: Bilateral lower lid retraction.

    Procedure performed: Bilateral revisional lower lid retraction repair using allodermposterior spacer graft.

Disclaimer:

*Individual results may vary

All before and after pictures displayed are real patients who have consented to having their pictures published on our site. Individual results will vary with each patient and Dr. Christopher Zoumalan does not guarantee any outcomes of procedures shown. All pictures are meant for reference and illustrative purposes only.

One of Dr. Zoumalan's specialty is correcting abnormal eyelid positions. Revision eyelid surgery is performed to correct the position of the eyelid after having undergone prior eyelid surgery, trauma, or following the removal of a tumor (ie skin cancer). Unsatisfactory results following eyelid surgery requires a very specialized surgical technique to achieve the desired result that was not achieved in the primary procedure. Dr. Zoumalan has extensive training and experience in revision eyelid surgery in Los Angeles.