Oculoplastic surgeon for lower eyelid repair
A large excision of skin from the lower lids can cause lower lid retraction. This is repaired with several techniques including cartilage grafting, mucosal grafting from the mouth, and canthopexy or canthoplasty whereby the skin is pulled up and tightened up to the lateral orbital rim. This should be done by an oculoplastic surgeon who has experience with this particular surgery.
It is tough to see the eyelid on this photo. In some circumstances ear cartilage can be used to help reposition an eyelid. I am not a big fan of this particular material but each surgeon has their own preference. It is not clear just from a photo which procedure would be best for you. The surgeon really needs to be able to feel the lid in order to make that assessment. Best of luck.
There are many ways to approach scleral show, what you have after your mole removal. Usually a cartilage graft is used if there has been injury to the middle lamella (the deeper support layer of the eyelid). This is usually not the case with mole removal, since this usually involves only the skin. The way to correct this problem is to recruit skin to replace what was removed. One can do this by reopening the wound and placing a skin graft, but this is not as cosmetic as one would like.
The other way is a modified blepharoplasty where the skin is elevated and supported by sutures into the covering of the bone. Sometimes a canthopexy to support the lid is also helpful. Of course, the only way to know any of this is with a careful examination, which could indicate an injury to the deeper structures and need for a cartilage graft.
If your prior mole removal just involved the skin then it is unlikely that a cartilage graft will be needed. Cartilage grafts are used when there is significant scarring in the inner layers of the eye lid. I can not see the eye lid clearly or feel the tissue but the elevation of the lower eye lid should be able to be accomplished with lifting of the muscle and skin.
Post-excision lid deformity
It sounds as if the removal of skin produced scleral show. It stands to reason that if everything has healed appropriately and enough time has elapsed for all the scarring to soften, that the real answer is a skin graft to replace the skin that is missing. Because this may produce more noticeable cosmetic deformity, although not always, alternative procedures may be called for that are not truly anatomically corrective.
A surgeon would have to do a careful examination of your periorbital region to come up with a possible solution. This could range from support from below (carlilage graft, infraorbital rim implant) or lid tightening (canthopexy). If you are experiencing tearing or dry eyes, more aggressive treatment might be warranted, otherwise the caveat is to do no additional harm.
Possible to raise eyelid without a graft
Scleral Show or lid retraction can occur post eyelid procedures performed even in the best of hands. Without examining you, it is impossible to state the best procedure for you. As you are smiling in the picture this may be elevating your eyelid. Tightening the surrounding eyelid muscles and lifting of the underlying cheek muscles may accomplish diminishing the eyelid retraction without using a graft. There are many excellent surgeons who could help you with this problem. I would suggest consulting an Ocular Plastic and Reconstructive surgeon as their expertise and training highlights the eyelid and its anatomy www.ASOPRS.org
Best of Luck.
Modified lower blepharoplasty can raise lower lid border.
This is just tentative, because your picture is not a close up and you are smiling, but my impression is that you may not need a cartilage graft. Shortening and/or raising the right lower eyelid with a modified lower blepharoplasty would probably be enough.
It is important to properly vet your reconstructive surgeon
Dear Eye Mole Girl
Things can happen with eyelid surgery. Ear cartilage is generally a very unacceptable material to use for reconstructing and eyelid. It is used by some. However, ear cartilage is much to thick and insufficiently pliable for the eyelid. For this reason, hard palate graft is preferred. In certain circumstances, cadaveric dermis (alloderm) can be used to stent the back surface of the lower eyelid. This is generally done in combination with a midface lift. The lift of the cheek recruits skin into the eyelid.
You surgeon should be a fellowship trained oculoplastic surgeon. Carefully study other reconstructive patients done by the particular surgeon you are thinking of working with. It is important to understand that there is only a small handful of surgeons in the country that can successfully perform the type of reconstruction you need. A good place to start is by identifying qualified surgeons by searching google under the topic of post-blepharoplasty eyelid recontruction. Then confirm that the surgeons you find are members of the American Society for Ophthalmic Plastic and Reconstructive Surgery.