Today's topic:
Mucosal Show, Lash Lift, and Upper-Lid Ectropion After Double Eyelid Surgery
When eyelid surgery does not go well, the conjunctival mucosa can become visibly exposed.
Some early-post-op mucosal show is simply swelling-related and tends to settle within about six months.
If mucosal show and a lash lift persist past six months, revision is warranted.
Cases like this — exposed mucosa with lashes pointing upward — show up after surgery.
You may have heard that double eyelid surgery can resolve congenital lash entropion (lashes turning inward).
Let me start with what causes the lashes to lift in this way.
Under normal fixation, the crease anchor point A should land at A'.
When the skin is in short supply, upward tension shifts the anchor closer to point B instead.
The lashes below the crease are pulled up along with it.
To correct this,
we dissect along the blue arrow, separating the orbicularis oculi from the tarsal plate.
This dissection can injure the orbicularis oculi and raises the risk of lagophthalmos.
Lagophthalmos is the inability to fully close the eye.
The orbicularis oculi is the muscle responsible for eye closure.
For that reason, I recommend correcting mucosal show conservatively — only to the extent that no functional complications result.
Even with that conservative approach, mucosal show improves substantially.
If a patient is willing to accept the risk of functional issues for a more aggressive correction, they should make that preference clear in advance.
Case 1.
Case 2.
