UNILATERAL LAGOPHTHALMOS AFTER UPPER BLEPHAROPLASTY: A CASE REPORT

Dermatochalasis is characterized by age-related loss of upper eyelid skin elasticity leading to excess folds. The aim of our study is to discuss the possible neurogenic mechanisms of temporary and unilateral lagophthalmos developing after upper blepharoplasty performed only with skin excision in a case presenting with dermatochalasis. A 52-year-old female patient with no systemic disease underwent bilateral upper blepharoplasty under conscious sedation with local anesthesia. Dissection was performed at the subcutaneous level, preserving the orbicularis oculi muscle and orbital septum. Symmetry and complete closure were present in the early postoperative period. On the 5th day post-op, lagophthalmos developed on the right side; wound healing was normal, and no excessive skin excision or scar tissue was detected. After mechanical causes were ruled out, it was thought that the condition could be due to neurogenic dysfunction or sensorimotor coordination disorder in the temporary motor branches of the facial nerve. The patient was administered 1 mg/kg/day of intravenous methylprednisolone for 3 days; significant improvement was observed on the 10th day and complete recovery occurred within three weeks. Unilateral temporary lagophthalmos occurring after upper blepharoplasty performed with skin excision alone may not always be due to a mechanical cause. Neurogenic mechanisms such as the effect of local anesthetics, temporary facial nerve conduction disorders, or sensorimotor coordination loss may contribute. To avoid unnecessary surgical revisions in patients without mechanical pathology, neurogenic and functional processes must be considered; spontaneous recovery is expected in most cases with conservative management and close follow-up.