Scleral Show with NEGATIVE Vector, Longevity of Canthopexy/Plasty? (photo)

I'm 19, & have 3.2-3.5 mm significant inferior scleral show. Never had surgery. UK Oculoplast realised I have negative vector & possible Euryblepharon – correct? Pushing cheeks up didn't impact sclera; she thought cheek lift unnecessary, & hard palate graft w/ canthoplasty best, but would only improve scleral show by 2mm, & lid retraction possible. If cheek lift was combined with a canthopexy/plasty and graft (like Madame Butterfly), could I remove all scleral show? Any other solutions?

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age 18-24 cheeks canthopexy scleral show

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6 Doctor Answers | Asked by canthopexy

Doctor Answers (6)
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Correction of lower eyelid retraction

Afternoon, I agree with some of the other surgeons that they canthopexy or canthoplasty alone will not address your issue and could make it worse. You do need to augment your midface and your Orbital rim while lengthening the overall height of the lower eyelid with the canthoplasty and a release of the lower eyelid retractors Followed by a mucosal graft on the posterior side of your eyelid. I hope that was helpful

Chase Lay, MD

18 reviews

Bay Area Facial Plastic Surgeon

www.chaselaymd.com

Canthoplasty/Canthopexy Longevity

You do not appear to have any significant euryblepharon, as your eyelids appear to rest against your globes. I would hold on the midface lift at this time. Canthopexy or canthoplasty would likely give significant improvement in scleral show and vector. I am not sure that you need a palatal mucosal graft either. However, I do not have the benefit of an exam. Bone anchoring canthoplasty has good longevity.

I'll detail the procedure, but I advise postponement until you are a little older

I understand that you’re not happy with your eyes and you want to do something about it. I can say to you that there a more than a few ways to address this anatomic feature. In my practice, I don’t operate on people your age unless there’s a clear medical indication. The majority of my patients with this type of problem have age-related issues or have this appearance as a consequence of eyelid surgery done elsewhere. They come to us because their eyelids are retracted. Lower eyelid... more

Lower eyelids are very delicate in their subject to risk with aesthetic surgery.

The photograph demonstrates scleral show between the iris in the lower lid. It appears that this is an aesthetic issue only. It might become functional if any operation is poorly executed or affected by unfortunate wound healing. I would advise you against any surgery.

Canthoplasty will not correct this.

Common misconception among inexperienced eyelid surgeons. Canthoplasty and pexy is used to address lax lower eyelids. That is not why your eyelids ride low on your globes. Shortening and tightening the lower eyelids will actually cause the lower eyelids to ride even lower on the eyes-the lower eyelids follow a geodesic on the globe surface. The madame butterfly procedure uses a spacer graft to lengthen the lower eyelid from the back of the eyelid. This procedure is... more

Kenneth D. Steinsapir, MD

8 reviews

Los Angeles Oculoplastic Surgeon

Negative vector

It is admirable that your surgeon has made note of the negative vector alignment. This is an important anatomical observation that is often missed with detrimental consequences. Since the negative vector general indicates a lack of inferior skeletal support to the lid and globe, not a laxity of the lid itself, the solution would begin with increasing that support, probably most effectively with some sort of malar implant. Whether or not there is additional vertical lid deficiency should be... more