Eyelid Surgery to Correct Protruding Lacrimal Gland?

Question

My upper eyelids are laxed and lacrimal gland is presently showing. I haven't gotten the surgery yet. I'm just trying to get a little insight on it before I decide to go through with it.
I'm going to be seen by one of the top oculoplastic surgeons in New Jersey. I'm still a little frightened. Any suggestions on what I should do?
I'm 21 and I hate to be called names cause of the excess skin and lacrimal gland that protrudes out the side of my eyes. I want a better appearance but I'm scared it may not work how I want it to

Ricardo A. Meade, MD · Answer

If you are seeing an oculoplastic surgeon then he is likely very well qualified to know the indications for the removal of your skin, and potentially resuspending your lacrimal gland.  Honestly, I would only go to a diplomate of the American Board of Plastic Surgery or an Oculoplastic surgeon. It is the simplest thing to suspend but over a period of a few years, the difficult thing is for it to stay.  Although placing a suture on the inner surface of the orbit is very, very simple, the gland's tendency is for it to drop.  Sometimes, the gland can be partially transected IF it's the problem. 
As stated earlier, the skin must be opened first then he'll need to dissect through the orbicularis muscle to see what's inside.  It kind of looks like you have prominent eyes, if that's the case then you may have somewhat dry eyes - that all needs to be evaluated and your oculoplastic surgeon has likely already taken all of this into consideration.
Best Wishes,
DoctorMeade

Richard J. Bruneteau, MD · Answer

Plastic surgeons occasionally encounter patients who have prominent lacrimal glands. This can occur for a variety of reasons including enlargement and malposition of the gland. These problems can result in significant aesthetic deformities. For this reason, patients frequently request treatment of these problems.It's unusual for someone who's only 21 to have this type of problem. Under these circumstances, it's appropriate to undergo a medical evaluation to rule out systemic disease processes. This evaluation may require blood work, CT scans and possibly MRI studies.It's normal for patients to be nervous about this type of problem. For this reason, it's important to do your homework and consult a board certified plastic surgeon with experience in this area. This surgeon should be able to formulate a treatment plan and hopefully, alleviate your anxiety.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thanks for the photo. It sounds like you have done a good job in selecting a surgeon with the qualifications to address your problem. I would recommend that you revisit with your oculoplastic surgeon and ask any additional questions, have him/her review the procedure and discuss his/her experience with the procedure. Once you have reached a comfort level with that surgeon's qualification and the manner that he/she will handle your issue it is okay to proceed. It is very normal to be a bit nervous before surgery.
I hope this is helpful.

Kenneth D. Steinsapir, MD · Answer

Dear Gaps
It would be very unusual for someone who is 21 to have lacrimal gland prolapse. Also you have abnormal upper eyelid creases in the area of eyelid fullness. I think before you have yourself ready to go for cosmetic eyelid surgery, someone needs to figure out why you lacrimal glands are enlarged. There are a few causes and you need to have the eyelid surgery work you up for conditions like Sarcoid and a few others. 
It might be appropriate to obtain a CT scan to determine how large the glands are and other features of the gland. A biopsy of one of the glands may also be appropriate before settling on an eyelid treatment. Once the cause has been determined and any appropriate treatment has been undertaken then it might be reasonable to surgically address any remaining issues. However, an appropriate work up is what should be done first.

Jeffrey E. Schreiber, MD, FACS · Answer

Hi Gapsfinest4eva - It appears as though you have a combination of excess skin and protruding lacrimal glands of your upper eyelids. The lacrimal gland is stitched up to the bone around the eyes to hold it up and in place. The excess skin is then trimmed off. The recovery is pretty easy with minimal discomfort. Good luck!

Scott Trimas, MD · Answer

Eyelid fullness in a young person can be corrected the same regardless of your age. If the lacrimal gland is protruding as maybe the case in you, it can be tucked up during your upper eyelid surgery so that it is no longer visible. The procedure is commonly done by an oculoplastic or facial plastic surgeon and it is a low risk procedure especially if done conservatively. The main risk you need to consider is how do you heal from scarring. Some African American skin types keloid and that could lead to a poor scar that is visible. Genearlly, if you have any other scars on you and they healed fine you should be fine then. I hope this information helps.

Robert W. Sheffield, MD · Answer

Thanks so much for the question and your attached photo! It is actually good that you are seeking advice and doing a research before diving into something new. Your fears and worries are understandable since this seems to be your first consultation regarding the issue. That said, if you are already scheduled for an appointment or check up with a board certified oculoplastic surgeon, then you should be in good hands. He or she will be able to give you proper and complete evaluation regarding the possible removal of excess skin on the lids as well as managing your lacrimal gland.  What you can do once you are in discussion with your plastic surgeon is to ask what possible issues are causing this protrusion and what options you have. Do not be afraid to ask questions. Do not be afraid in asking for alternative options as well, if you do not want to go under the knife. Best of luck!

Chris Thiagarajah, MD · Answer

First off, a protruding lacrimal gland is something that needs to be evaluated. Enlargement of the lacrimal gland can be caused by inflammatory diseases such as sarcoidosis, sjogrens disease, wegener's disease or even some type of blood disorders. I would not go ahead and get this fixed until those are evaluated.

William Portuese, MD · Answer

See an oculoplastic surgeon who has lots of experience performing this type of surgery. It is important to have the gland re-suspended up into the orbital area and not have the gland removed; otherwise you will have dry eyes. It is important to have good functioning of the lacrimal gland; however, it needs to be tucked up inside the orbital rim, when it is hanging down it creates a visual deformity.

Christopher L. Hess, MD · Answer

Lateral upper eyelid fullness can really only be caused by two things.  First, the lacrimal gland can descend from under the orbital rim.  Second, certain people can get a significant amount. of ROOF (retro obicularis oculi fat).  It's often a very find line in diagnosing the difference between the two.  Some times you can fell the lacrimal gland but often there is a combination of the two.
The only real way to diagnose the situation is at the time of surgery.  Either way if the gland had descended it is resutured up under the orbital rim.  If it's ROOF fat this is also easily removed.
Don't worry, if you have faith in your surgeon and he knows how to handle each of these situations you'll be fine.

Eyelid Surgery to Correct Protruding Lacrimal Gland?

Answers (18)

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