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Will Blepharoplasty Affect my Vision?

My eyes are more open than they should be, so it looks very scary at times. They are naturally like that. If I get my bottom eyelids tightened, will I still have perfect vision?

For example if I look down, will my bottom eyelids move down or will it stay in its place because of tightness? If it stays in place, I won't see anything when I look down because my bottom eyelids will cover my pupils.

So is it possible for me to get surgery on my bottom eyelids? Thank you very much for your time.

Dino

Doctor Answers (12)

You will still be able to see after Blepharoplasty

+2

The short answer to your questions is that after surgery, you will still be able to see when looking down. There are different ways to correct the scleral show - the whites of your eyes being visible. The most likely scenario for you is a midface lift with hard palate graft. As an oculoplastic surgeon, this is a procedure that I do routinely. There are other options, but I would need to examine you to know for sure the best treatment options.


Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Lower blepharoplasty is risky for you because of prominent eye with scleral show

+1

You have a prominent eye which is called proptosis. Your eye ball is bulging or pushed forward against the lower eyelid. The result is that the lower eyelid is pushed forward and does not completely cover the eyeball which is why you see white of the eye below your Iris and pupil.

The white eye tissue is called sclera and when you see white below the Iris and pupil it is called 'scleral show".

A lower eyelid blepharoplasty done through an external incsion will shorten the lower eyelid and make your scleral show worse and can result in ectropion a very serious complication of blepharoplasty which can cause eye damage.

You should not have a standard lower blepharplasty through an external eyelid incision.

There are complex occuloplastic procedures which can be done to lessen the bulge of the eye (orbital decompression) and elevate the lower eyelid (canthopexy or canthoplasty).

However, your eyes look young and I do not see any reason for blepharoplasty. If you have dry eyes or are very uncomfortable with the bulge then see an occuloplastic surgeon for a consult.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 26 reviews

Properly performed blepharoplasty will not affect vision

+1

A properly performed upper and/or lower blepharoplasty will not affect the vision. If there happens to be severe dermatochalasis of the upper lids which is interfering with vision, this will actually improve the field of view, if not the acuity of the eyelids. A physician can perform just upper blepharoplasty, just a lower blepharoplasty, or both.

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 55 reviews

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Lower eyelid elevation techniques will help

+1

With the multiplexity of solutions provided by our excellent doctors online, it becomes important to discern what technique will elevate the lower lid with the least chance of creating another aesthetic disturbance. Volume filling can accomplish this with release of the orbicularis occuli muscle. The other techniqes can also achieve this but side effects are commom and they would not be my first choice. We have published techiques on elevation of the lower eyelid by subperiosteal dissection and filling of the lower eyelid. It is a quick recovery option and should not "make matters worse."

Richard Gentile, MD
Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 19 reviews

Yes

+1

I've seen some interesting answers to this question. First I don't think you have proptosis. This means your globe is moved forward, "bulging" eyes. Because your upper lid in sligtly ptotic, low, you don't have proptosis.

So you have a congenital, either lid laxity or ectropion. No problem. You need a canthopexy. The lower lid canthus, suspensory ligament, is divided then resutured higher up on the orbital rim.

To be honest you likely will have temporary vision changes but not permanent.

Good luck

Christopher L. Hess, MD
Fairfax Plastic Surgeon
5.0 out of 5 stars 16 reviews

Another option is orbit decompression

+1

The other surgeons' comments about the stability of your lower eyelid retractors allowing you to see normally when looking down after a lower eyelid recession are correct. However, a lower eyelid "tightening" procedure will not help your scleral show, it may actually your globe appear more prominent, similar to how tightening a belt on an obese person will just make the belly hang over the belt even more.

Another option is to address the fundamental aesthetic problem: your globe is relatively prominent in relation to your orbit bone and soft tissue anatomy. When this happens to people with a medical problem, it's called proptosis. This can happen to people with orbital tumors or Graves' disease. However, it is very common for black, asian, east indian and middle eastern people to have "cosmetic proptosis" with no medical problem.

A great treatment for proptosis is orbital decompression of the soft tissues and fat in the orbit to let the eye sink back into the orbit. With a less prominent position, the eyelid will ride up higher and you will appear less "scary." This could be combined with a lower eyelid retractor spacer through the same incision to allow the lower eyelid to ride up a little higher. This can and has been done for cosmetic reasons.

Good luck!

Tanuj Nakra, MD, FACS
Austin Oculoplastic Surgeon
4.5 out of 5 stars 3 reviews

Challenging Deformity

+1

I just read Dr. Steinsapir's insight and advice which demonstrates the complexity of your situation very well. Scleral show and rounding of the lower lids is a known complication after lower blepharoplasty. Even in practices of busy cosmetic blepharoplasty surgeons yours is a very rare problem. Certainly, a tarsal-strip procedure or canthopexy will likely not be effective. My advice would be to seek an oculoplasty surgeon experienced with state-of-the-art midface work and eyelid reconstruction.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 24 reviews

When you look down, the lower eyelid retractors pull the lower eyelid down.

+1

Hi Dino

You need a complex surgery to address your relative proptosis. The eyes are prominent with a relatively weak orbital rim. In addition, you have midface descent.

As a result, the weight of the cheek is not supported by the cheek bone at the orbital rim. The weight of the cheek pulls at the lower eyelid causing the lower eyelid to ride too low. A simple canthoplasty will not correct this situation.

You need to have the cheek lifted vertically to the orbital rim and then the lower eyelid needs to be lengthened using a hard palate graft to vertically elongate the lower eyelid across the width of the lower eyelid. This is done with a hard palate graft taken from the roof of the mouth. The graft is sewn in behind the lower eyelid so that the results are cosmetically acceptable. Initially the newly position lower eyelid is quite stiff and it is possible to experience seening the lower eyelid when you look down. Over time the eyelid softens and this effect gradually diminishes. The cheek is held to the orbital rim with the placement of a hand carved ePTFE orbital rim implant that is fixed to the bone with titanium microscrews.

Please feel free to look at my website: lidlift.com for more discussion of this technique for addressing midface and lower eyelid issues.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Very effective visuals

+1

Dino,
Great photographic documentation of your current appearance and where you'd like to go. Fortunately, it's not quite accurate with regard to the third photo, which depicts the lower lid being held up and blocking the pupillary opening. Meaning that you can have your scleral show corrected and not affect your field of vision. In the photo, you have COMPLETELY defunctionalized the lower eyelid muscle retractor system. In reality, when you tighten or raise the lower eyelid the muscle/retractor system continues to function and lowers the lid as you look down. Of course, this doesn't change the fact that one of the risks of any eyelid surgery is loss of vision. Again, fortunately, this risk is EXTREMELY rare. Good luck!

Kenneth R. Francis, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 31 reviews

Well performed lower eyelid surgery will not affect your vision.

+1

Hi! Both your lower eyelids and the outer corners of your eyes are too low. Both contribute to the undesirable look and both need to be corrected.

The surgery does not replicate the motion you are doing in the photo and should definitely not affect your vision. You need a lower blepharoplasty and a canthoplasty.

This is tricky surgery. Be sure you go to someone who does a lot of this. An oculoplastic surgeon is a good choice. Ask to see before and after pictures.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.