Fixing the multi-operated eyelid

This 62 year old woman came from the Midwest for relief from the following problems: tearing and irritation on the left side.  Her story started in 2010, when she underwent bilateral lower lid cosmetic blepharoplasty.  Since then, she has had three surgeries to attempt to correct her left lower lid.

Preoperative photos were obtained which revealed a suture abscess at the other corner of the left lid/cheek junction, as well as loss of integrity of the lower lid attachments, causing the lower lid to fold out during blinking.  This latter problem has caused her tearing and discomfort at night while she sleeps.  She is depicted below, before surgery:

Suture abscess noted as a raised red lesion.

The upper eyelid folds inside of the lower eyelid during blinking.

The same patient is depicted under general anesthesia, in the operating room.   It is clear that the eye does not close normally. This complex reconstruction was performed under general anesthesia, although many reconstructions do not require that level of anesthesia. Generally speaking, when there are a lot of anatomical unknowns, such as in the multi-operated patient,   it is best to have these procedures under general anesthesia when medically acceptable.

She underwent the following procedure:  lateral canthoplasty with drill-hole eyelid fixation to bone, with collagen tissue patch reinforcement.  The drill-hole technique was required since her tissue was abnormal after multiple surgical procedures.  The tissue reinforcement was required since she actually had a tissue shortage laterally:  somewhere along the line, her eyelid had been shortened surgically, and there was not enough tissue of substance to hold a suture.

Her postoperative course was uncomplicated.  Finally, 4.5 months after surgery, the patient returns for a final postoperative visit.   She has complete relief of symptoms.   Postoperative photos are depicted below:

Normal blink is restored.