lower lid retraction after quadblepharoplasty and cantophexy 9yrs ago a yr later skin pinch incision on both eyes and another one a year later, improved a little, but still some sclera show specially on rt. eye. Need advice on what procedure will suit me better. Pictures before surgery both eyes even.after surgeries and skin pinch incisions on both eyes wow sclera show. Sad sad sad ...
Lower Lid Retraction After Quadblepharoplasty and Canthopexy- Need Reconstruction, What Are My Options? (photo)
Doctor Answers 5
You need your lower eyelids vertically and horizontally lengthened.
You posted the other day. The photos are very helpful. Many surgeons might propose tightening the lower eye to fix your issue. This will not help and is likely to cause the lower eyelids to ride lower on the corneal surface. You have scar in the lower eyelid which is responsible for the shortening vertically. The horizontal shortening is from the prior canthal surgery. The most efficient means of accomplishing this reconstruction is with a skin graft. Unfortunately a skin graft to the lower eyelid is aesthetically unacceptable. For this reason other, more complex strategies are used to vertically and horizontally lengthen the lower eyelid. Extra skin can be recruited into the lower eyelid by vertical advancing the cheek. The shape of the lower eyelid can be controlled using a posterior eyelid graft. My preferred material continues to be hard palate graft borrowed from the roof of the mouth. I also use a hand carved orbital rim implant to help anchor the advanced cheek permanently. You can see the effects of this type of surgery by looking on my website lidlift dot com.
Scleral show after pinch blepharoplasty
The rounding of your eyes and scleral show is likely related to the subsequent pinch blepharoplasty you had performed after your initial surgery. This the most common complication after pinch blepharoplasty and the reason why the indications to perform this procedure are very limited.
Seems like you will need to recruit skin to your lid with a mid cheek lift and grafting to the lower eyelid to help support and elevate the lid.
Hope this was helpful. Good luck!
I think you answered your own question. Too much skin was removed causing the scleral show even with a canthopexy. Am exam is critical to figure out what to do for you. A skin graft may be necessary or even a palatal graft if the inner lamellae is tight. Maybe a cheek lift? Hard to say without an exam.
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Lower Eyelid Reconstruction For Shortening
Such amounts of lower eyelid shortening are unusual from the more conservative pinch excision approach to a lower blepharoplasty. But your degree of ectropion poses a challenge as the simplest and most assured solution is a skin graft which, while effectively raising the eyelid, will produce a very unsightly external patch or scar below the lashline. As a result, more sophisticated reconstructive methods are needed which included grafting on the inside of the lower eyelid and an external cheek lift. This 'inside and out' approach to lower eyelid ectropion is needed to increase the actual height of the lower eyelid which addresses the real underlying problem.
Ectropion after lower blepharoplasty
I cannot understand why if the first skin removal was excessive causing the ectropion why you would have 2 more skin excision procedures. After this many years the innermost layer of the eyelid will be deficient even if none of the conjunctival mucosa on the inner surface was removed in any of the previous operations. The treatment then is adding tissue to the superficial (skin) and deep (mucosal)layers of the eyelid. I suspect you will also have scar tissue in the middle layer that will need to be released.
I have personally not been impressed by the ability of midface or cheek lifts to recruit cheek skin into the lower eyelids and keep it there.
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