Eyelid Problems After Surgery or Aesthetic Procedures - Real Cases and Real Lessons

The eyelids are small in size but incredibly complex. They rely on the balance between the eyelid crease, levator function, brow support, canthal tendons, and midface tension. When any of these are altered, especially without proper preoperative diagnosis or postoperative follow-up, the entire periorbital region can be affected.

Here are several real cases that highlight how varied eyelid problems can be, and why accurate assessment matters.

Case 1: Three Procedures Done at Once, Without Clear Communication

A young woman travelled overseas expecting a straightforward eyelid procedure. Instead, she underwent three separate operations in the same sitting, none of which were properly explained.

1. A forehead lift

She was told this would “open up her eyes,” even though she did not have brow ptosis. This unnecessarily pulled her brows and therefore her eyelid crease higher than her natural position.

2. Eyelid crease lowering

In the same surgery, the surgeon then attempted to lower the eyelid crease back down again. However, the crease was set too low, largely because the aesthetic ideal in that country favours a low, subtle crease close to the lash line. This is quite different from what many of our Southeast Asian patients prefer.

This difference in aesthetic goals was not discussed pre-operatively, leaving her with a result she did not expect.

3. Lateral canthoplasty

A lateral canthoplasty was also performed during the same operation, again without clear explanation of why it was needed.

She returned home with multiple delicate procedures done but:

• with no postoperative guidance,

• no understanding of what had actually been done, and

• no plan for follow-up once she flew home.

How She Eventually Ended Up Seeing Me

She initially went to a GP for stitch removal. The GP struggled, because lateral canthoplasty sutures are not routine stitches and should not be removed casually.

Removing the wrong suture can destabilise the canthus, leading to:

• rounding of the eye,

• downward drift,

• persistent tightness, or

• visible scleral show.

Recognising the risk, the GP advised her to seek a plastic surgeon. When she came to me, she had:

• a too-low upper lid crease,

• asymmetric brow position,

• early lower-lid tightness, and

• non-absorbable canthal sutures that required precise removal under magnification.

I then guided her through what to expect in terms of recovery as she had not received this information before her surgery.

Lesson from Case 1

Eyelid surgery must begin with proper diagnosis and a clear discussion of aesthetic goals. A forehead lift she never needed led to an elevated crease, followed by an overcorrection, all compounded by the lack of postoperative care once she returned home. A single misdiagnosis triggered a cascade of arguably unnecessary procedures.

Case 2: “Droopy Eyelid” After Botulinum Toxin Abroad - Two Problems, Two Causes

A different patient came to me worried she had developed a droopy eyelid after receiving Botulinum toxin overseas. On examination, she actually had two separate issues, each requiring different management.

1. True eyelid ptosis caused by Botulinum toxin diffusion

The first problem was a genuine eyelid droop on one side due to Botulinum toxin diffusing into the levator muscle, a known complication. This was not a pre-existing anatomical issue and largely due to poor injection technique.

I performed targeted injections to the palpebral portion of the orbicularis oculi to help reduce the downward pull, and her eyelid position improved as expected.

2. Brow ptosis unmasked once the forehead muscles (frontalis) were paralysed

She also had long-standing compensated brow ptosis and excess upper eyelid skin. Before treatment, she subconsciously lifted her brows using her forehead muscles, masking the heaviness.

Once the Botulinum toxin paralysed these muscles, the brow descended to its true position, lower than she realised. This then created the ongoing sensation of heaviness even after the eyelid ptosis had improved.

Lesson from Case 2

Botulinum toxin can reveal underlying anatomy that patients never knew they had. The eyelid and brow can both contribute to heaviness, and treating one does not address the other. Proper diagnosis prevents unnecessary anxiety and complications.

Case 3: Early Ectropion One Month After Lower Eyelid Surgery

Another patient underwent lower eyelid surgery overseas using a subciliary approach, However, about one month postop, she noticed:

• outward turning of the lower eyelid,

• irritation of her cornea, and

• changes in eyelid position.

She received next to no guidance at all during this period, and early warning signs were dismissed. While her overseas surgeon was willing to revise the ectropion, she still had to travel back across countries for the correction. Unfortunately, not long after the revision, the ectropion recurred again.

This illustrates that no one approach is risk-free, especially without structured follow-up.

Lesson from Case 3

Complications may not always show up immediately. A proper postoperative review is essential to identify issues while they may still be potentially reversible.

Why Eyelid Problems Are So Easily Misunderstood

The eyelids, brows, canthal tendons, and midface function in cohesion. A small change in one area can affect the rest. That’s why:

• A too-low crease may result from overcorrection, not swelling.

• A “simple stitch removal” may risk undoing a canthoplasty.

• A “droopy eyelid” may be brow descent unmasked by Botulinum toxin.

• Ectropion can appear subtle at first but worsen without review.

Accurate assessment ensures the right issue is addressed at the right time.

Takeaway

Eyelid surgery is one of the most intricate areas in cosmetic surgery. When done without proper diagnosis, when multiple procedures are performed together, or when aftercare is lacking, problems can arise quickly, or quietly, weeks later.

If you’ve had eyelid surgery or periocular treatments overseas and are unsure about your healing, seek an early review. Careful assessment can make a significant difference in keeping results safe, stable, and natural.

Written by Dr Ng Zhi Yang, Singapore Plastic Surgeon, and Founder & Medical Director of Doctor Stitch, a specialist-led cosmetic surgery aftercare service.