What Approach to Choose for Drooping Eyelid Revision?

One of my eyelids is drooping about 1 mm lower than the other and showing white under my iris. I've now had consultations with 3 oculoplastic surgeons about correcting this problem, and each one has suggested a different approach. One suggested I try to Restylane to boost it up, another suggested a canthoplasty and Alloderm spacer, and the last said I don't need an Alloderm spacer and a canthopexy should fix it (even though my 2 previous revision attempts by my original surgery were canthopexies too). My last revision surgery was 8 months ago. Help - I'm so confused!

Doctor Answers 5

Scleral show

Quite frankly without examining you it is difficult to say what to do. Maybe nothing.  You may need a resuspension. If the canthopexy did not work, then a formal canthoplasty may be necessary but it may change the angle in the corner of your eye.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

4th time's a charm? I doubt it

Yes, you do have some drooping but I must admit that it is minor.  If it does not cause any visual problems or tearing problems you might want to leave it alone for a year or two.  At least then all the scars will have settled down and softened up.  Every time you go in you have a higher risk of healing and scarring problems.  Look up the best oculoplastic surgeons in your area as there are plastic surgeons who specialize in only eye plastic surgery.  I would not rush to operate.

Steven Schuster, MD, FACS
Boca Raton Plastic Surgeon
4.0 out of 5 stars 8 reviews

drooping eyelid revision

You already had 2 operations or maybe 3 counting the first operation. WOW! Maybe you should consider the risks/benefit ratio of any more surgery. I question a 1 mm difference is an acceptable result. I question your realistic expectations.

Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

Based on the picture cantoplasty will be more successful

I would like to know what approach was used and do you have any original pictures before original  surgery. What was your original complain? You had 3 surgeries so far and your lower eyelid sagging is noticeable ,but should also consider the possibility of complications and not achieving the perfect result.

In person physical examination(lid movement, quality of the skin an amount of scar tissue)is a must before final recommendation.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 124 reviews

You are on the right track but you need a surgeon you are comfortable with.

I would advise you to continue to interview eye plastic surgeons.  You need to do a little more research on those who specialize in fixing eyelids after cosmetic surgery.  The first task is proper diagnosis of the problem.  As I look at you your right globe sits lower in the face than the left globe.   Also I get the impression that the left eye may be more prominent that the right eye.

Restylane can temporarily help the lid margin but it does not really correct the problem.  This is an issue that really does require a surgical correction in my opinion. 

Left canthoplasty will not in itself be successful in "boosting" up the left lower eyelid margin.  Canthoplasty involves horizontally shortening the lower eyelid and then refixing the eyelid to the orbital rim.  This will cause the eyelid margin to ride lower on the left eye than it currently does.  This has to do with some complex topology but the eyelid will find the shortest path on the surface of the globe.  I assure you the result of this isolated procedure will surprise the surgeon who performs it and it will complete depress you.  Inserting the Alloderm to support the eyelid is the right direction.  Internal lid spaces are used as an alternative to placing an unsightly skin graft.  However, the Alloderm does not survive.  What it does is it splints the healing eyelid to prevent it from being pulled down more by the healing process.  I do occasionally use Alloderm for this purpose.  However, when absolute control on the eyelid margin shape is needed (as in your case), the preferred material is hard palate graft taken from the roof of the mouth.  A long pendent shaped strip of material is harvested.  The benefit of using this material is that it does not absorb so the lid margin shaping it provides does not disappear which can happen with Alloderm.

Regarding the right upper eyelid ptosis, this requires some testing to determine the best approach.  However, I think that you might benefit from ptosis surgery plus a microblepharoplasty.  The goal of this procedure is to remove the small amount of excess skin that causes the skin pleating in the upper eyelid platform.  An anterior approach for the droopy eyelid allows for adjustment of the lid height and the removal of skin below the upper eyelid crease.

Obviously, there are many details to this type of reconstructive surgery.  I encourage you to study my website which contains an abundant amount of material on these types of procedures: http://www.lidlift.com/fixing/

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.