How are eye spacer grafts placed? (Photo)

Question

I was recomended a eye spacer graft taken from the roof of my mouth to lift up my eyelid. My questions is where /how is the graft placed and does it raise the entire eyeball up or just the lid. Pic enclosed. I feel my issue isnt really the lid but entire is sits lower

Mehryar (Ray) Taban, MD, FACS · Answer

Spacer graft is used to elevate the lower eyelid, not the eyeball. It is placed inside the lower eyelid. However, spacer graft is not always necessary to raise the lower eyelid as I have published on this matter. Consultation is required to better help you.

Kenneth D. Steinsapir, MD · Answer

My approach uses both posterior lower eyelid grafts and a hand carved orbital rim implant made of ePTFE.  The graft is used to lengthen the lower eyelid and does not raise the eye itself.  The quality of your photographs is not ideal.  However I am also concerned that you have a lower eyelid adhesion syndrome.  Bottom line the hard palate graft will not improve the position of the right eye but it will help better protect the cornea and make you more comfortable.  There is no substitute for experience with these procedures.

Steve Laverson, MD, FACS · Answer

You’re correct.  Based on submitted portrait, your brows, eyeids, globe (eyeball), and entire orbit (eyeball socket) appear higher on one side than the other.  This situation is called “orbital dystopia,” and is not uncommon.  You’re also correct that while your lower eyelid may be a bit lower (more scleral show) on the low side in relation to your globe, it’s not a dramatic malposition and it’s acceptably symmetric visually.  It’s improper to offer (or accept) definitive advice without personal consultation, but in general, I believe a spacer graft lower lid elevation holds the potential for WORSENING your asymmetry by adding an element of difference in palpebral aperture.

Johnson C. Lee, MD · Answer

A spacer graft is usually placed through the inside of your eyelid to help lengthen and prop up the lower eyelid depending on what layers are shortened or stuck down. It will not affect your eyeball position and only supports the eyelid. Hope this clarifies things!Johnson C. Lee, MD Plastic Surgery@Drjohnsonlee

William H. Jervis, MD, FACS (in memoriam) · Answer

the graft would be for the eyelid only and not change the position of the globe ( eyeball ).  this condition is clearly in the realm of an ophthalmic plastic surgeon, almost always an opthamologist with specialty training in plastic surgery of the eyelids. this is important because the lower lid is critical in keeping the tear film intact and the surface of the eyeball with protective moisture.  of interest is this result of elective eyelid surgery, an injury, or did this naturally occur or develop spontaneously?

How are eye spacer grafts placed? (Photo)

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