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Too Much of the Whites in my Eyes Show How Can This Be Fixed?

I was born like this I have not had surgery or any problems with my eyes. This is for cosemtic reasons only. Too much of the whites show at the bottom of my eyes and it make my eyes look different and I would like to know if this can be fixed?

Doctor Answers (10)

Midface issue

+3

Dear Shonrea,

A full face photograph would be very helpful as how you position your face will have an effect on the degree of white showing under the colored portion of the eye. This show of white is called inferior scleral show.

Normally, the lower eyelid margin rides the eye just at the inferior limbus. The limbus in the circle defined on the eye where the colored portion of the eye meets the white portion of the eye. So yes, it is true that your lower eyelid rides very low on the eye. Another way of thinking about this issue is that the eye is very prominent relative to the projection of your cheek bone.

Now to understand the issue a little more fully, it is important to understand a little bit about the geometry of curved objects like the surface of the eye. When a plane flies form say Los Angeles to London, the pilot does not fly a straight line from one city to the other. This is because on a spherical object like our planet earth, the shortest distance between to points is not a straight line but rather a curved line, called a geodesic. So the pilot flies what is called a polar route between Los Angeles and London. This curved path follows a geodesic arch between these two cities which defines the shortest distance between these cities.

The same phenomena is important to understand when it comes to eyelid surgery because the eye is not flat but instead is spherical. You may consult plastic surgeons who offer to perform a procedure called a canthopexy or canthoplasty. These are slightly different procedures that involve tightening or shortening the eyelid with the intent of lifting the lid margin higher up on the eye. Well this will not only not work, but this will actually force the eyelid to ride even lower on the eye due to the spherical shape of the eye. It is kind of like what happens when someone tightens their belt and the pants and belt slide under the fullness of the belly. Ouch.

As a result of this under appreciated geometry, as you can image, a lot of well meaning plastic surgeons run into a lot of trouble with this type of lower eyelid surgery. I end up fixing these types of problems. In your case, you have not had surgery, this is how you come and it is the relative position of your eye to the edge of the cheek bone that accounts for this situation.

It is helpful for someone like yourself to explore how much lower eyelid elevation you will tolerate. Recognize that big eyes are considered to be beautiful. When the eyelid is lifted up, the eyes will be perceived to be smaller. It is important as part of the consultation to explore the happy balance between the apparent bigness of the eyes and the desire to have the eyelid cover more of the eye. In terms of how to actual raise the lower eyelid, it is important to elevate the cheek.

In your case with means improving the projection of the cheek bone at the orbital rim. I do this with a swinging eyelid approach working primarily behind the lower eyelid so there is virtually no skin incision. A custom hand carved ePTFE orbital rim implant is made at the time of surgery and this extends the projection of the orbital rim. Next the cheek is lifted onto this implant. The lower eyelid needs to be lengthened across the entire eyelid. This is done by using hard palate graft from the roof of the mouth. Finally the canthal angle is reformed and the eye is sewn closed for 1 week. The other side is done at a separate surgery one week later. Obviously this is a very big undertaking.


Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

To fix or not to fix, that is the question

+2

Many physicians and researchers have spent considerable time determining what the "most attractive" eyes are. We know angles, depth, skin, fat and many other things that are accepted to be the norms and the most attractive.

One of those things is scleral show or how much white of the eye is seen below the iris or colored part of the eye. The "studies" have dictated that the lower lid should come up to the lower boarder to 2mm over the lower iris.

However, I have a close friend who has significant scleral show and is very attractive. So this isn't always true. Your eyes appear this way. They seen quite attractive. However, if you're unhappy a lower lid canthoplasty can easily correct this. Remember, you've been this way your whole life and this is how people know you. So think long and hard before you consider surgery.

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

Excessive white showing of the eyes

+2

Your eyes are unique in that the upper portion of the pigmented portion of the eye is covered by the lid, while the lower portion shows a fair amount of white (sclera). This is a variant of a normal eye configuration. If the amount is objectionable or causes dry eye syndrome, it can be corrected. Your picture was not taken at a completely straight angle, and patients looking upward, especially patients with a prominent globe, will appear to have a problem worse than it actually is.

First, the patient has a medical evaluation to make sure they do not have a medical reason for the globe being prominent, for example the thyroid gland being too active.

In our experience, a canthopexy (upward tightening of the corner of the eye) alone can produce an oddly shaped eye, with a severe uptick at the corner of the eye while the central portion of the lower eyelid remains low, producing a catlike appearance.

We prefer, when surgery is warranted, to perform a cheeklift with a lateral only ultrashort incision (USIC), elevate the midface and along with it the center of the lower eyelid, to produce a more almond shaped eye. When combined with a canthopexy, this can produce a more natural eye appearance while minimizing the tendency toward scleral show. Your eyes will always be your eyes to some extent, so the goal of the surgery will be to reduce, but not eliminate the scleral show.

This procedure is technically complex and we urge patients not to undergo it unless there is a clear reason to do surgery.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

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Canthopexy or canthoplasty is the treatment for this

+2

Scleral show, which is what you are describing, can be an acquired defect after surgery or it can be congenital. If there are no functional issues, surgery is not truly necessary. However, if you are bothered by its cosmetic appearance, then I recommend a tightening procedure of the lower lid called canthopexy. Depending on the prominence of your eyes and the inherent tightening that is needed, there are a few types that can be recommended.

Sepehr Egrari, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 29 reviews

Various methods to raise lower eyelids

+1

Regarding ways to reduce the amount of white showing beneath your eyes, there are various methods to raise the lower eyelids. The least option (other than doing nothing) is to try injecting filler to the lower eyelids. Sometime this is all that is needed.

 

Sometimes a canthoplasty will help. In this procedure, the lower eyelid is tightened at the outer corner of the eyelids. In your case and with your big eyes, I'm not sure that is the best treatment for you.

 

A midfacelift to raise the cheeks may be another option. This is sometimes done along with a canthoplasty procedure.

 

Some patients need a midface implant for more projection along with a midface lift. Judging from your (very small) photo in only one view, it does not appear that you need the implant.

 

Oculoplastic surgeons are specialists in plastic surgery around the eyes and may be best suited to address your concerns.A personal, in -office consultation will yield a lot more information and help you answer your question more definitively.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 32 reviews

Scleral show

+1

This is called scleral show and can be either congenital or from previous blepharoplasty surgery, and it can be from taking too much skin out of the lower eyelids. This can be fixed through a canthopexy or canthoplasty where an incision is made at the lateral corner of the eye, and it is brought up and tightened up and sewn to the bone on the lateral orbital rim. This technique will bring up the eyelid and stop the scleral show, but it does tend to change the shape of the eyelid a little bit and make the shape of the eye look more almond-eyed.

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

Yes, scleral show can be fixed

+1

Start with the basics. A complete exam by your plastic surgeon to assess the eyelid structures. This extra show of white of the eye is not uncommon in people of color, but still, consideration must be given to the possibility of other conditions that could cause this, like Grave's disease, a thyroid condition that affects the eyes.

After all that has been checked out, lid tightening or raising procedures can be performed. Be sure that the surgeon you choose is comfortable with the procedures, as it requires a bit more finess than just a blepharoplasty.

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

My recommendation is to leave it alone

+1

My initial reaction would be to leave your eyes as they are.  However, if you want a second opinion, I sometimes refer patients with your concern to a colleague across the street from my office in New York City. 

His name is Dr. Glen Jelks, and he may have had experience with your problem before.

Darrick E. Antell, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

See an Ophthamologist to make sure you don't have proptosis

+1

I would have an eye exam to make sure you don't have proptosis or a bulging eye. Throid problems can cause this.

Most likely, you just have scleral show, that is, more of the white showing below your iris (the colored part of your eye).

Most commonly, this happens when the cheek is lower or flatter as opposed to a high cheek bone. This is the facial structure that you inherited.

The only reason to have surgery would be if your eyes become irritated by wind, dust etc.

A canthoplasty can pull the lower lid up, but this would create scarring that is visible on your eyelid skin, and I don't think it is worth this risk.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
4.5 out of 5 stars 29 reviews

Scleral show

+1

You do have some scleral show. As long as your eyes can close normally without any dryness you do not need surgery.

If you are doing this to change the shape of your eyes, a procedure that would support the lower lid structures and tighten the outer cathus will address this issue. A word of caution about this procedure as the lower lid is a very sensitive structure and there is a high risk for problems.

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 4 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.