Hi, I am considering lower Blepharoplasty and pinching at the sides of eyes to help with my Graves eye disease. I had orbital fat removal 1 year ago but my eyes still protrude more than I like. An Oculoplastic surgeon suggested taking a graft from the roof of my mouth for the lower eye lid procedure. Is this common and safe?Thank you Any suggestions would be appreciated.
Blepharoplasty Graves Disease
Doctor Answers 9
Lower Blepharoplasty Using Skin Graft from Roof of Mouth
To specifically answer your question, yes, using a hard palate graft is common and safe. Oculoplastic surgeons commonly do this. I assume you have discussed this versus other treatments with your Oculoplastic surgeon, who is the correct specialist to treat Graves orbitopathy.
Hard palate graft is safe in the right hands
Lower eyelid surgery using a hard palate graft is safe when done by a properly trained, experienced surgeon. Other options for treatment of thyroid eye disease are eyelid lowering (if your eyelids are retracted), or orbital decompression can help the eyes to move back into a more normal place in the eye socket (if the eyelids are bulging).
An oculoplastic surgeon is well-suited to perform these surgeries.
It is important to have the same goal as your surgeon.
An oculoplastic surgeon is definitely the right type of specialist. However, it is important that you and your surgeon have the same goals. I assume that your eye prominence is mild enough that a bony orbital decompression was not an option and instead a fat decompression was performed. Photos would be very helpful to better understand your actual situation. However, from your description you have a prominent eye with the lower eyelids ride low under the curve of the lower eyelid with significant inferior scleral show. The surgery proposed by the oculoplastic surgeon you saw can definitely lengthen your lower eyelid vertically to allow it ride a little higher on the eye. However, pinching the outer corner together surgically (lateral tarsorrhaphy) will alter the natural almond shape of the eye. The sclera or white of the eye in the outer corner between the eyelids will be smaller and this change may not be to your liking. If the goal is not cosmetic but rather functional to address eye irritation, or corneal drying this trade off may be acceptable. However, if your goal is aesthetic improvement, I do not believe that you will very happy with this compromise. This makes me wonder if you and your oculoplastic surgeon are on the same wavelength. Craniofacial surgeons might address this deficiency by advancing the midface skeleton to increase the projection of the inferior orbital rim. Again this is a powerful approach that lack the aesthetic finesse that you are likely to need to avoid a freakish change in your facial appearance. A better alternative I believe is to augment the orbital rim. Yaremchuk uses a prefabricated porous polyethylene orbital rim implant. I on the other hand prefer a hand carved ePTFE rim implant that I combine with a vertical lift of the cheek soft tissues and the hard palate graft. This preserves the almond shape of the eyes. My website has more information on this procedure.
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Lower Blepharoplasty Using Skin Graft from Roof of Mouth
Without an in person examination and photos very hard to advise. But it sounds like an acceptable treatment plan. From MIAMI Dr. Darryl J. Blinski
Treatment of orbital symptoms in Grave's disease
Prior to proceeding with the eyelid surgery, there may be other options that would be more effective. I recommend discussing the case with your surgeon and asking the medial orbital walls could be treated to help decrease the eye bulging. This is one of the most common surgical procedures performed for patients who have Grave's disease.
Grave's eye disease
The treatment of bulging eyes form Grave's disease may require imput from several specialist including a craniofacial surgeon to possibly require bony orbital work to allow the volume for the globe to increase.
Treatment of Grave's Eye Disease
As treatment of the orbital complications of Graves Disease is a problem that spans different medical specialties, I would recommend that you consult with an ENT (Otolaryngologist) that specializes in this treatment for a second opinion. In order to properly answer your question, more information is needed and must be reviewed. If the ENT feels that your prior surgery was adequate and nothing more can be done, then you can move ahead with the palatal graft with confidence.
Dealing with Graves' Disease of the Eyes - Bulging Eye Balls
Regarding: "Lower Blepharoplasty Using Skin Graft from Roof of Mouth
Hi, I am considering lower Blepharoplasty and pinching at the sides of eyes to help with my Graves eye disease. I had orbital fat removal 1 year ago but my eyes still protrude more than I like. An Oculoplastic surgeon suggested taking a graft from the roof of my mouth for the lower eye lid procedure. Is this common and safe?Thank you Any suggestions would be appreciated."
Grave's (Basedow's) Disease involves large secretion of Thyroid hormone in response to an autoimmune stimulation of thyroid hormone receptors. The eye muscles and fat around the eyes become swollen due tremendous infiltration by immune cells. Enlargement of these muscles and inflammatory shortening of the levator muscles lift the lids and give the eyes a protruding classic appearance.
The solution here is to enlarge the eye socket volume by ORBITAL DECOMPRESSION. In MY opinion, operating on a normal lower lid may be a mistake. A hard palate mucosal graft is usually used as a stiffener to prevent scar retraction / cicatricial pulling of the lower lid down. I would go this way only after a professional attempt of orbital decompression. In the meantime, it is important for you to keep the eyes from drying.
Dr. Peter Aldea
Lower lids with palatal grafts
A lower lid surgery in the face of Grave's Disease is very complicated and carries the risk of ectropion much more significantly that in regular patients. The palatal grafts are done for some circumstances to add stiffness to the lower lid and to try to prevent the ectropion from occurring in the first place.
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.