Ectropion means that the lower eyelid is “rolled out” away from the eye, or is sagging away from the eye. The sagging lower eyelid leaves the eye exposed and dry. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.
Generally the condition is the result of tissue relaxation associated with aging, although it may also occur as a result of facial nerve paralysis (due to Bell’s palsy, stroke or other neurologic conditions), trauma, scarring, previous surgeries or skin cancer.
Selecting the right surgeon for ectropion surgery is very important. When performing surgery in one of the most delicate skin areas of your entire body that also has one of the most intricate anatomy, the pool of surgeons qualified to perform such a procedure shrinks dramatically.
When dealing with any problem near the eye, you need to see a physician trained as an ophthalmologist. Many doctors are not comfortable working in that area because of the specialized anatomy and will refer you to an ophthalmologist anyway. Additionally, because this is an extraocular procedure (outside of the eye) as opposed to an intraocular procedure (inside of the eye), the best choice for ectropion surgery is an oculoplastic surgeon (also known as an ophthalmic plastic and reconstructive surgeon).
A well-trained oculoplastic surgeon can combine their knowledge of the eye with the artistic expertise of a plastic surgeon. You need a doctor that can ensure that the procedure is done correctly, but also won’t leave an unsightly scar near your eyes. Dr. Liu is an oculoplastic surgeon and has completed an ASOPRS fellowship, making her one of the most highly qualified oculoplastic surgeons in North America.
Ectropion surgery can be performed under local anesthesia in Dr. Liu’s procedure room or under sedation at an off-site surgery center, but only in very rare cases would general anesthesia be used.
Dr. Liu begins by making an incision by the outer corner of your eye. She then tightens the lateral tendon that supports the lower eyelid and attaches to the bony orbit. The lower eyelid may or may not be shortened depending on how loose it is. The corner of the eye is then reformed and the skin incisions are closed with dissolvable sutures that do not need to be removed in the office. Sometimes an additional incision is made on the inside corner of the eye or the eyelid to tighten the medial tendon that supports the lower eyelid and attaches to the bony orbit or to turn the eyelid inward.
Occasionally, if there is a lot of scarring or loss of skin on the eyelid, Dr. Liu may need to place a skin graft from the other eyelid, behind your ear, above your clavicle, or from your arm to reconstruct the eyelid. If this is the case, the eyelids may need to be closed and a patch placed over the eye for approximately 1 week.
The specific techniques that Dr. Liu uses will be selected based on your needs. Because Dr. Liu has such specialized training, she has access to a number of techniques that are not utilized by most other doctors, and she may mix and match these techniques to get the best outcome.
Ectropion surgery typically takes about 1-2 hours from start to finish.
Ectropion surgery may have a scar at the incision site, but it is usually not obvious. Dr. Liu makes the incision in the lateral upper lid crease, next to the eye, or right by the eyelashes to help minimize the visible scarring. Non-specialized surgeons typically have results with more visible scarring.
Ectropion surgery is generally a very safe procedure. When considering any eyelid surgery, it is important to inform your surgeon of any abnormalities of your eyes, vision, or your general medical health. Dr. Liu requires all eyelid surgery patients to have a full eye exam with dilation completed within the last year before scheduling surgery.
It is important to remember that while all surgery carries some risks, even when performed by the most highly trained surgeon and at the best facilities. Below are some of the more common risks associated with eyelid surgery:
The likelihood of serious complications arising from the procedure is typically influenced by both the surgeon’s skill as well as the patient’s individual response to the eyelid surgery. Certain severe risks or complications can be avoided by cooperating fully and completely following your surgeon’s instructions. With patience, a willingness to cooperate, and a qualified surgeon, the complications of eyelid surgery and any associated risks can be dramatically reduced.
Surgery should be scheduled for a time when you can relax for at least 1-2 weeks. It is important to avoid any strenuous activity, heavy lifting, or bending down during this time to avoid complications and to promote the best healing. It is also important to avoid taking any blood thinning medications for at least two weeks prior to surgery. If you are on a blood thinning medication due to a specific medical condition, you will need to discuss this with Dr. Liu and your primary care physician prior to stopping any medication. Dr. Liu’s staff will review a list of common medications, supplements and vitamins that can cause your blood to be thinner.
Please note that Dr. Liu expects to see patients back in the office a few days after a procedure to ensure that the healing process is going as expected and that you are on track for a good result. Do not plan any travel immediately after your procedure.