What is the appropriate surgery for lower eyelid retraction? (Photos)

Question

I'm 18 and I have lower eyelid retraction/ectropion that begin in puberty, causing functional discomfort and insecurity. I would like to resolve the scleral show, have my eyelid sit against my eye and raise my canthal tilt. I thought I’d need infraorbital implants or a spacer graft plus canthoplasty, but an NHS opthalmologist said a spacer graft might worsen the issue by pushing the eyelid forward. I may pursue private treatment. I've also noticed that my orbital vector seems positive, but my outer orbit sits low. I'm not sure whether my orbitals are recessed, nor which surgeries to look into. Any help would be much appreciated. I am squinting in one of the photos to make my infraorbital bone more visible.

Steve Laverson, MD, FACS · Answer

You already know about infraorbital implants, spacer grafts, canthopexy, canthal tilt, and negative vector so have seen experts and become educated.  Any lower lid lift may detrimentally narrow your palpebral aperture so upper lid levator advancement may also be indicated.  Professional treatment  recommendations can only follow a clear understanding of your desired changes, thorough ophthalmologic and ocular adnexal exam including exophthalmometry and thyroid assessment, and physical simulation of results with you in the mirror.  Once your desired outcome is agreed upon, a surgical plan can be formulated.

What is the appropriate surgery for lower eyelid retraction? (Photos)

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