if one had round eyes and scleral show due to BOTH a recessed orbital rim area AND lax under eye, and wanted to get both procedures, which one should be done first generally to a produce a more predictable aesthetic variable?
Orbital Rim Implants, Lateral Cantho Plasty and -Plexy - In What Order?
Doctor Answers (7)
Canthal surgery alone will never address these issues.
WIth few exceptions, the syndrome your are describing is caused by damaging lower eyelid surgery coupled with midface ptosis. Poor cheek bone and therefore orbital rim projection contribute to the issues. It would be very unusual to need this time of work as a primary aesthetic surgery. If that is your situation, unless you have some type of craniofacial abnormality, you will be talking yourself into way more surgery than you need!
Canthal surgery alone, such as canthoplasty or canthopexy are never adequate to address these problems. A canthopexy is used to stabilize a lower eyelid but is incapable of addressing a pulled down or rounded lower eyelid. The canthoplasty is an actual reconstruction of the outer corner of the eyelids. However, alone this procedure is not powerful enough to correct the situation you are describing.
It is for this reason that orbital rim implants are utilized to help vertically lift the cheek and recruit more skin into the lower eyelid without resorting to a skin graft. It is for this reason that hard palate grafts are used behind the lower eyelid to lengthen and control the shape of the lower eyelid to prevent the distortion that will occur if one attempts to solely correct the lower eyelid with a canthoplasty.
Assuming that you have such a complex problem, yes definite surgery includes all of these options to adequately address the issues associated with the syndrome you are describing. A personal consultation is ultimately needed to determine what is best your actual situation.
Recessed orbital rims
I would seek second and third opinions regarding a diagnosis of "recessed orbital rim" from board - certified plastic surgeons. This is not a common finding. The use of implants in the face often results in disappointing results. Very few surgeons in the country can use implants in the face without distorting one's appearance. Make sure you are seeing a surgeon certified by the American Board of Plastic Surgery.
Samer W. Cabbabe, M.D.
Board - Certified Plastic Surgeon
St. Louis Plastic Surgery Consultants
Orbital Rim Implants and Tightening the loose lower lid
Regarding: "Orbital Rim Implants, Lateral Cantho Plasty and -Plexy - In What Order?
if one had round eyes and scleral show due to BOTH a recessed orbital rim area AND lax under eye, and wanted to get both procedures, which one should be done first generally to a produce a more predictable aesthetic variable?"
Without a photograph much less an essential physical examination, we'll assume that you absolutely require orbital rim implants to correct a bulging eye (proptosis) and lack of support of the lower lid but that you do not require other procedures nor have other condition.
In such a scenario, you would have ONE operation in which the orbital rim implants were placed first and then you had bilateral canthopexies or canthoplasties depending on the amount of residual lower lid looseness and need for tightening (Canthopexy for minor corrections, canthplasty for moderate and major support of the lower lid).
Dr. Peter Aldea
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I would recommend that both procedures can be done if needed at the same operation. Whether a canthopexy or canthoplasty is needed is determined on the amount of lower eyelid laxity.
I am assuming that you have a proptotic eye with a very recessed orbital rim. I recommend that you consult with an experienced oculoplastic surgeon. These are the surgeons most qualified to handle your eyelids. If you are in LA, UCLA has an excellent oculoplastic department.
Orbital Rim Implants, Lateral Cantho Plasty and -Plexy - In What Order
You need an extensive orbital soft tissue, bony workup before an intelligent answer to your question can be determined. With that stated I agree with Dr Wallach in details to extensive and reasons to involved to explain here. seek ONLY in person evaluations.