Correction of Ectropion Caused by Lower Blepharoplasty and Lower Lateral Canthoplasty

A case of correcting recurrent under-eye fat and lower lateral canthoplasty issues 17 years after lower blepharoplasty

Hello,

I am Yoo Young-gi, chief director of Roy Plastic Surgery.

Today, I’d like to introduce a revision lower blepharoplasty case for a woman in her late 40s.

She had already undergone lower blepharoplasty 17 years ago,

and also had a history of outer canthoplasty and lower lateral canthoplasty.

The biggest concern was scleral show under the eyes.

Due to the effects of the lower lateral canthoplasty, the lower eyelid was pulled too far downward,

and she said the problem of tears pooling and running down easily was severe.

In addition, because the previous lower blepharoplasty involved only

simple fat removal rather than fat repositioning,

over time the fat protruded again,

resulting in recurrence.

This made the under-eye area look even more protruded,

and since the function of the eyelid itself had also worsened,

she was often told that she looked “unnatural and tired.”

Preoperative condition & problems • Ectropion:

As a complication after lower lateral canthoplasty, the lower eyelid was excessively turned outward,

exposing the sclera and conjunctiva, causing a lot of tearing and a stinging sensation.

In particular, the patient was most bothered by the visible reddish mucosa.

• Recurrent under-eye fat:

Because only simple removal had been done previously,

the remaining fat became protruded again over time.

• Deficiency of under-eye fat: On the other hand, some areas lacked the necessary fat

and appeared sunken.

The combination of “protrusion + hollowing”

created an overall uneven appearance.

Also, since ectropion had already developed,

simply repeating lower blepharoplasty could have worsened the aftereffects of the lower lateral canthoplasty.

Therefore, it was necessary to lift or support the lower eyelid,

and we determined that the sagging midface tissue around the cheekbone area also needed to be improved at the same time for a proper solution.

Surgical plan:

Revision lower blepharoplasty + lateral canthopexy

• fat repositioning & grafting

• midface lift

(1) Revision lower blepharoplasty and fat repositioning

The problem from the previous surgery was that it ended with “fat removal only,”

so this time the recurrent fat needed to be properly repositioned,

and the deficient areas had to be filled.

The uneven protruding fat was planned to be flattened,

and the sunken areas were designed to have a smooth curve.

(2) Under-eye fat grafting

Fat was grafted into the deficient areas to restore balance in volume.

No matter how much repositioning is done, once removed, fat is difficult to restore completely,

so under-eye fat grafting was performed together to create a more natural and firmer line.

(3) Lateral canthopexy

If the lower eyelid has been opened too much due to lower lateral canthoplasty and the sclera is exposed,

a process to fix the outer canthus is essential.

Through this, the eyelid can return to its original position,

improving excessive scleral show and excessive tearing.

(4) Midface lift

If ectropion is already present and only lower blepharoplasty is performed by itself,

the lower eyelid may be pulled downward again over time by gravity.

By lifting and securing the midface tissue around the cheekbones together,

the tendency for the lower eyelid to be drawn downward can be minimized.

This procedure is called a midface lift,

and it also has the advantage of improving the cheek volume around the cheekbones, which tends to sag in middle age and later.

Postoperative changes

This is how it looked 10 days after surgery.

• Before:

A generally unnatural impression with severe scleral show,

recurrent under-eye fat that was uneven,

and sunken areas coexisting.

• After:

Scleral show was significantly reduced and the under-eye line became flatter,

creating a natural and relaxed-looking eye area.

Visible reddish mucosa was minimized.

If we summarize the postoperative changes,

they are as follows.

1. Improvement of scleral show under the eyes

The outer canthus was firmly fixed and a midface lift was performed together,

preventing the under-eye area from being pulled too far downward.

As a result, ectropion improved significantly,

tears no longer ran down excessively, and the appearance also became more natural.

2. Effects of fat repositioning & grafting

While neatly arranging the recurrent fat,

fat was grafted into the deficient areas,

so the uneven under-eye line changed to a smoother one.

Previously, the eyelid was turned outward,

exposing the reddish mucosal area and giving a harsh impression,

but after surgery it changed to a brighter and softer atmosphere.

3. Stable results through midface lift

Not only was the immediate result satisfying,

but to prevent the lower eyelid from sagging further in the long term,

the midface area was lifted and secured.

Cautions

• If there is already an aftereffect from lower lateral canthoplasty or outer canthoplasty, such as ectropion,

simple revision surgery alone may not be enough.

Since the support structure of the under-eye area has weakened,

a combined surgical plan such as a midface lift may be necessary,

so we recommend having a thorough consultation with a specialist.

• If you had lower blepharoplasty in the past and the fat has protruded again,

or the under-eye area has become hollow,

or the sclera has become excessively exposed,

stable results can be achieved only by comprehensively considering each element,

such as “fat repositioning, lateral canthopexy, and midface lift.”

• After surgery, swelling and bruising may occur for a certain period of time,

so it is helpful to support recovery with cold compresses and rest,

and to carefully follow the care instructions provided by the clinic (such as no smoking, no drinking, and avoiding excessive exercise).

We hope this case helped you better understand revision lower blepharoplasty and the correction of complications after lower lateral canthoplasty.

Many people actually visit us after undergoing multiple eye surgeries and carrying concerns, but if you find a customized solution that matches the patient’s condition,

you can still regain a natural-looking eye area.

If you have any questions, please feel free to contact us anytime. Thank you.

If you are curious about scars after lower blepharoplasty,

click the link below :)

https://blog.naver.com/youngkeeyoumd/223378540111

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Roy Plastic Surgery Clinic (Line 3, Sinsa Station) Main phone: 02-516-5525

Weekdays 10:00 ~ 19:00 Saturday 10:00 ~ 16:00

Roy Plastic Surgery complies with the Medical Service Act. The photos in this post were taken under the same conditions,

and are images taken with the patient’s prior consent. In addition, after plastic surgery and procedures, side effects such as bleeding, infection, and inflammation may occur depending on the individual, so caution is required.​