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Lower Eyelid Retraction Getting Worse Each Year. What To Do? (photo)

I've had problems with lower eyelid retraction since I was in my late teens, especially with the left eye. My eyes make me look tired, sad and mad. I've had a suggestion for canthopexy and another for a mid facelift with browlift and enduragen graft (if necessary). My cheek bone is a problem as is my lack of facial fat. How long can I expect a mid face lift to last? Is there any other procedure that could help support the lower eyelids? I want to stay on the conservative side. Thank You

Doctor Answers (14)

Canthopexy is not the best and most reliable means of lifting the outer canthal angle!

+4

WIth due respect to Dr. Friedenthal, canthopex will actually worsen your inferior scleral show.  Canthopexy effectively shortens the lower eyelid.  This means that the lower eyelid will find the shortest path around the globe.  This shortest path is currently a curved path just under the colored portion of the eye.   Shortenting the lower eyelid with a canthopexy will force the lower eyelid to follow an even shorter curve around the eye which will paradoxically cause  the lower eyelid to sit even lower on the eye after surgery.  For similar reasons, midface surgeries will also be problematic for you.  Under eye fillers can be a helpful option.  I encourage you to study these options on my website.  Don't rush into surgery for this issue as fixing bad midface surgery is much more expensive that the original midface surgery.  I am concerned that you have done enough research to get yourself into trouble.


Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

You dont have lid retraction

+3

You have an anti mongoloid slant where the lateral canthus is lower than the medial. Cathopexy will indeed make this worse. I have just returned from Vancouver asaps meeting and seen surprising. Even scleral show diminished by fat grafting. results in lower lids with judicious fat grafting. I've seen experienced plastic surgeons drop mid facelift in preference to fat grafting

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 17 reviews

Lower Lid Position

+1

The photos show an anti-mongoloid slant of the eyes and relative midfacial hypoplasia.  These findings in facial terms are sometimes referred to as "polar bear" syndrome.  I would recommend extreme caution in pursuing surgical options, because a large portion of the problem is a lack of midfacial volume and structure as opposed to eyelid laxity.  I would suggest incremental use of Sculptra (at least 3 sessions) or fat grafting to address this issue.  Surgery may compound your aesthetic concerns with functional problems.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 35 reviews

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Fat Grafting and Fillers

+1

   Fat grafting or fillers to the area may help, but an exam will be necessary to assess eyelid laxity and level of support.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 218 reviews

Increased sceral show and downward slant to outer corners of the eyes

+1

Midface lifts and canthoplasty / canthopexy could help but it could make it worse. You would be taking a significant risk with these procedures. It really depends on how important it is for you. But you could look worse than you are right now. Fillers and fat injections could help a bit and I would start with these. Midface lift and canthal procedures would be one of the last resorts.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 37 reviews

Sagging lower eyelids

+1

Your posted photo shows outer eyelid corners lower than inner (even more so on the left) and lower eyelid margins slope downward with a bit of a notching on the left lower eyelid. It is not possible to make any recommendation merely on the basis of this photo. We need to know how supple the eyelids are. If they are tight and you try a canthopexy or canthoplasty alone you will make the situation much worse. Suppleness is not something you can assess from a photo. It is something you note in a face to face examination. I suspect you will need repositioning of the outer corners and a graft (possibly a composite graft) to increase support for the eyelids. I cannot see how fat grafting alone or injection of a dermal filler would help you at all. I think that would be a waste of time and money.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Drooping lower lids

+1

Hello Piancu -

I agree with Dr. Ellenbogen and Dr. Steinsapir - your eyes are slanted downward. This is not lid retraction.

A canthopexy and/or a midface lift will not help and will lead to new problems that will be hard to reverse. 

Conservatively? Fat grafting. You are likely to need a series of treatments. Also you need a very careful facial analysis to see what more, e.g additional fillers, can be done to help you.

Best wishes. 

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.5 out of 5 stars 21 reviews

Lower lid retraction repair

+1

A midface lift without the underlying support will not be long lasting result in my opinion.

You certainly have low lateral canthal position [canthal dystopia]. A posterior eyelid graft with Enduragen, or Hard palate with canthopexy/plasty would be a good start for you if you want to be more conservative.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 22 reviews

Sad Eyes - What is the Best Surgery

+1

Many surgeries COULD be done but there all come with a potential "price" - and I do not mean money. Midface lifts in conjunction with canthopexy or canthoplasty may be an option. Even in expert hands this can easily result in asymmetries, worsening of your condition or just a different but not better look.

If you would be my relative I would start with conservative fat grafting only to improve upon the described volume issues and take it from there. Less is often more - certainly in your situation.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.5 out of 5 stars 27 reviews

Lower lids

+1

The shape of your eyes indicate a lot of scleral show.  This means you show much more of the white part of the eye ( the sclera ) than does the average person. It can be d difficult problem to correct and either a cant hooey or a mid face lift are possible solutions.  Make sure you go to a surgeon experienced with the procedure.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 11 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.