Ectropion after a lower eyelid lift can be caused by excessive skin removal, scarring or pre-existing eyelid instability. Certain measures are important to prevent it or treat it at an early stage. 1. preventive measures If a lower eyelid correction is planned, the following measures can reduce the risk of ectropion: Surgical prevention A gentle surgical technique: the surgeon should perform moderate skin removal to avoid over-tightening. Muscle and connective tissue strengthening: Techniques such as a lateral canthopexy (fixation of the eyelid angle) or strengthening of the septum can reduce the risk. Patient-specific planning: People with a weak lower eyelid (e.g. due to age, previous surgery or connective tissue weakness) should be operated on with particular care. Postoperative preventive measures: Cooling: Direct swelling can be minimized by gentle cooling (e.g. gel pads, not directly on the skin) Elevation of the head: In the first few days after surgery, the head should be elevated when sleeping. No heavy physical exertion: Sport and heavy pressure (e.g. heavy lifting) should be avoided for at least 2 – 4 weeks. Eye moisturization: Artificial tears or moisturizing ointments can be used to prevent dryness. 2. treatment of a mild ectropion (early, non-surgical) If an incipient ectropion becomes apparent after surgery, conservative therapy can often help: Drug therapy Tear substitutes (artificial tears) prevent dryness and protect the conjunctiva. Eye ointments (e.g. with dexpanthenol or hyaluronic acid) help to keep the eye moist overnight. Anti-inflammatory medication (e.g. drops or ointments containing cortisone) can reduce swelling and scarring. Physiotherapeutic measures Eyelid massages: The eyelid can be brought into the correct position by gently massaging it with the fingers. Adhesive technique (taping): Taping can stabilize the eyelid upwards while it heals. Exercises to strengthen the eyelid muscles: Special eye exercises can help to improve eyelid tension. 3. treatment of a permanent or pronounced ectropion (surgical) If the ectropion persists or worsens after 3-6 months, various surgical corrections may be necessary: a) Lateral canthopexy / canthoplasty Fixation of the outer eyelid angle to reattach the eyelid to the eye. This is often combined with a tightening of the lower eye muscle. b) Skin or connective tissue transplantation If too much skin has been removed, a skin transplant (e.g. from the upper eyelid or behind the ear) may be necessary. Alternatively, a flap graft can be made from the surrounding skin. c) Tarsal shortening (eyelid shortening) If the lower eyelid is too droopy, it can be stabilized by shortening the eyelid margin.
d) Scar lasering and connective tissue reconstruction If scar tissue pulls the eyelid downwards, scar correction or an injection with autologous fat or hyaluronic acid can help. Summary Early measures such as eye drops, massages and taping can help to prevent or correct an ectropion. If there is no improvement after 6 months, surgical correction is often necessary. Close consultation with an experienced ophthalmologist or plastic surgeon is essential.