Drooping Lower Eyelids or Scleral Show Due to Cheekbone Structure?

I have droopy lower eyelids ('Sanpaku'/ScleralShow) at 19 years old. Over the past few years, I've had bad sleep patterns (bedtime 'procrastination').

However, research has lead me to believe that lack of sleep may not actually be my underlying problem. I asked my doctor about this, and he said the elasticity should return after getting sufficient sleep.

My question is, judging by the photo, does it look like my lowerlids are drooped due to a possibly weak cheekbone structure? I was thinking of just slightly squinting a lot to 'strengthen' the muscles responsible, but that would lead to wrinkles, apparently.

Doctor Answers 4

Drooping of lower eyelids is in the bones

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A side view would be best to make judgments about the cheek bone. But given your age and facial structure I would guess that weak (hypo plastic) cheek bones play a role in your scleral show. The elasticity will not improve with sleep. One option to consider is an orbital rim/ malar implant with a canthoplasty. This might nicely address your concerns.

Madison Facial Plastic Surgeon
4.7 out of 5 stars 44 reviews

Poor cheek support affecting your eyelid

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I agree with your assessment of the poor cheek support causing the appearance of fatigue in your eyes. Having said that, over-activity of the muscles will not correct that. Weak structure can only be improved with improved structure. Your case maybe one where the tissues of the mid face or cheek are surgically lifted up and draped into a higher location. At times, cheek implant can also give structural support that is needed and that can make your orbit appear better supported.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Canthopexy or canthoplasty for drooping lower lids.

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It appears from the picture that there is a lateral rounding of the lower lid with some scleral show. This is not due to your sleep patterns. This can be repaired by an oculoplastic surgeon through a canthopexy or canthoplasty technique, which will actually bring that outer portion of the eyelid up and will be fixed at the orbital rim and bone at the outer corner of the eye.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

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Cheek Support Will Help The Lower Eyelid

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You have made a great observation. I hope you become an artist or a plastic surgeon. You need support in your cheek bones and under the lower eyelid area to push up the lower eyelids. The other procedure that can help is called 'Canthopexy'. However, looking at your photo there is a lack of volume in the cheeks.

Squinting or other exercises will not help.

I would suggest Sculptra as a filler which would increase the volume of the cheeks and lower eyelid areas. If that fails then you can try fat injections using your own fat.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 122 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.