It can be reversed in some cases. However, the method depends on how widespread the adhesion inside the eyelid is. If the adhesion is not extensive, lateral canthoplasty restoration alone may suffice, but if it is extensive, adhesiolysis and lateral canthopexy may be considered together.
Lower eyelid surgery to improve aging around the eyes and lateral canthoplasty to expand the eye horizontally are known as representative eyelid surgery procedures that create a refreshed eye appearance. However, when the two surgeries are performed excessively or severe tissue adhesion occurs, the lower eyelid may not adhere closely to the eyeball and may turn outward, resulting in ectropion. Ectropion can bring functional inconvenience such as not only redness of the eyes but also epiphora (excessive tearing) and lagophthalmos (incomplete eye closure), requiring accurate analysis of the cause and stepwise treatment approaches. This article examines the causes of ectropion that can occur after lower eyelid surgery and lateral canthoplasty procedures, and explores improvement methods using lateral canthoplasty restoration, lateral canthopexy, and adhesiolysis from a clinical perspective.
What Is Ectropion: Definition and Main Symptoms
Ectropion is a condition in which the lower eyelid does not adhere closely to the eyeball and turns outward, and can be accompanied by functional problems such as epiphora and lagophthalmos.
Ectropion occurs when the structures supporting the eyelid become weak or when the downward tension becomes abnormally strong. If skin is excessively removed during lower eyelid surgery or strong scar adhesion forms inside the surgical area, the lower eyelid can be pulled downward. When this is combined with weakened support of the lateral canthus ligament due to lateral canthoplasty to open the eye corner, the eyelid may not withstand the tension and progress to ectropion where it turns outward. In this condition, lagophthalmos where there is a gap even when closing the eyes, and epiphora where tears flow excessively as a protective response to dry eyes, often appear together. If symptoms are left untreated, discomfort may continue for approximately 1-3 months or more depending on individual differences, so early evaluation is recommended.
Why Ectropion Occurs After Lower Eyelid Surgery and Lateral Canthoplasty
Ectropion is categorized as mild or moderate and above depending on the extent of adhesion in the lower eyelid area and the degree of reduced support of the lateral canthus ligament, so the approach differs accordingly.
Even if eyelid eversion does not appear severe to the naked eye, the degree of internal functional damage may be more severe than that. When extensive adhesion is formed solidly along the previous lower eyelid incision line, vertical movement of the lower eyelid may be significantly reduced and elasticity recovery may also decrease. In this condition, if only simple lateral canthoplasty restoration is performed to correct only the eye corner ligament, there is a possibility that ectropion may not improve sufficiently or recur because it cannot overcome the adhesion pulling downward. On the other hand, when ectropion is relatively mild and the adhesion range is not extensive, cases are being reported where improvement can be expected from lateral canthoplasty restoration correction alone. As such, the treatment direction is generally determined after evaluating the extent of adhesion and the degree of reduced eyelid movement through 1-2 detailed examinations.
Treatment Comparison: Lateral Canthoplasty Restoration Alone vs. Adhesiolysis and Lateral Canthopexy Combined
Depending on the adhesion range and severity of ectropion, an appropriate method may differ between lateral canthoplasty restoration correction alone and adhesiolysis and lateral canthopexy combined treatment.
There are differences in approach depending on whether adhesion is not severe and only the lateral canthus ligament support is weakened, or whether extensive adhesion along the lower eyelid incision line is present. The table below compares general characteristics of the two treatment directions.
| Category | Lateral Canthoplasty Restoration Alone | Adhesiolysis + Lateral Canthopexy Combined |
|---|---|---|
| Suitable cases | When ectropion is mild and adhesion range is not extensive | When extensive adhesion and reduced lower eyelid movement are accompanied |
| Suture removal timing | Approximately 5-7 days | Approximately 7-9 days |
| Swelling and tension relief timing | Approximately 2-4 weeks | Approximately 4-8 weeks |
| Approach method | Focus on eye corner ligament realignment | Adhesion release followed by fixing ligament to orbital bone |
| Expected changes | Eye corner opening, adhesion improvement | Expanded functional improvement including ectropion, epiphora, lagophthalmos |
Adhesiolysis is the process of carefully releasing internal scar tissue pulling on the lower eyelid to make eyelid movement more flexible, and lateral canthopexy is the process of fixing the loosened eye corner ligament to the orbital bone periosteum to rebuild support so the eyelid does not turn inside out again. It is reported that performing both procedures together is more favorable for securing structural stability as the adhesion range increases.
Post-Surgical Recovery Progress and Management Considerations
From around 7-9 days when sutures are removed, lower eyelid adhesion tends to improve gradually, though individual variations may occur.
Once the structural support of the lower eyelid is restored, from around 7-9 days when sutures are removed, the eyelid tends to adhere to the eyeball and phenomena such as excessive tearing or incomplete eye closure may be alleviated compared to before surgery. However, when lateral canthopexy is accompanied, the fixed area may feel heavy or the eye corner may feel somewhat stiff due to the nature of the process of firmly fixing the drooping eyelid to the orbital bone. This is known as a general reaction that appears in the fixed process to support the loosened structure again, and tends to be gradually alleviated between approximately 4-8 weeks when acute swelling subsides and the ligament settles into place. Recovery speed and pattern may vary depending on individual factors such as the degree of adhesion and tissue condition.
Diagnosis and Treatment Approach at Sheone Plastic surgery
After detailed evaluation of adhesion extent and tension direction, diagnostic and treatment procedures that guide structurally sound restoration directions can be utilized for ectropion improvement.
The process of addressing eye appearance with progressive adhesion and accompanying functional damage from multiple surgeries may not be sufficient with only a one-dimensional approach of erasing scars. A comprehensive evaluation process is needed of the degree of insufficient lower eyelid skin, the direction of tension pulling the eyelid, and the depth of internal scar tissue. Sheone Plastic surgery (a plastic surgery clinic specializing in eye surgery and eye revision surgery) bases its clinical principles on guiding structurally sound restoration directions within the range allowed by the patient's anatomical conditions, drawing on clinical experience related to eye revision surgery such as lateral canthoplasty restoration, lateral canthopexy, and adhesiolysis. In the diagnosis stage, treatment plans are typically established after confirming the extent of adhesion and eyelid movement through 1-2 detailed consultations. If there is external or functional inconvenience due to eye surgery complications, it is recommended to confirm a treatment plan suitable for you through a clinical process that analyzes the causes by layer.
Frequently Asked Questions (FAQ)
Q1. Why does my eyelid turn inside out and tears flow after lower eyelid surgery and lateral canthoplasty?
If skin is excessively removed during lower eyelid surgery or strong internal adhesion is formed, the lower eyelid can be pulled downward. When this is combined with weakened lateral canthus ligament support due to lateral canthoplasty, the eyelid may not withstand the tension and ectropion may develop where it turns outward. During this process, lagophthalmos and epiphora can occur together.
Q2. My ectropion doesn't look severe, but do I need to have adhesiolysis and lateral canthopexy together?
Even if eyelid eversion appears minor to the eye, the internal adhesion extent and degree of reduced eyelid movement may differ. If extensive adhesion is formed along the previous incision line, simple lateral canthoplasty restoration alone may not overcome the adhesion force for sufficient improvement or may have a risk of recurrence, so combining adhesiolysis and lateral canthopexy may be considered depending on the adhesion range.
Q3. How long is the recovery period if I have adhesiolysis and lateral canthopexy together?
Though individual variations exist, sutures are typically removed around 7-9 days, and initial tension and swelling tend to be gradually alleviated between approximately 4-8 weeks as the ligament settles into place. Recovery speed may vary depending on the degree of adhesion and tissue condition.
Q4. I've had lower eyelid surgery and lateral canthoplasty multiple times with extensive adhesion, but can improvement still be achieved?
Even when extensive adhesion has formed, an approach through carefully separating scar tissue via adhesiolysis and rebuilding the support structure through lateral canthopexy can be considered. However, treatment plans and recovery patterns may differ depending on tissue condition and degree of adhesion, so a specialist's detailed diagnosis should precede this.
Q5. When does the tension or awkward feeling in my eyes become comfortable after surgery?
Immediately after lateral canthopexy, tension and stiffness may occur due to the nature of the process of fixing the ligament to the orbital bone. This is a general reaction that occurs in the fixed process to support the structure again, and tends to be gradually alleviated from the time acute swelling subsides.
Treatment results may vary depending on individual health conditions, so please be sure to consult with a specialist.