I have lagophthalmos, and I no longer want my eyes stuck together, giving me a strange look at 28 years of age. I already had canthopexy done and it left one of my eyes with scleral area visible at the bottom. Can these problems be corrected, taking cosmetic appearance into consideration?
Correcting Lagophthalmos and Lateral Scleral Showing?
Doctor Answers 6
Absolutely yes but you need to go to a doctor who specializes in this work.
You did not share with us you pictures. You also did not say how you developed lagophthalmos, which means that your eyelids do not close.
Isolated canthoplasty can elevate the lower eyelid but at the risk of altering the shape of the lower eyelid. People who have prominent eyes often find that the lower eyelid is pulled even more under the eye by the procedure. For others, the angle of the outer corner can be altered in an undesirable fashion. The best approach, particularly if there has been prior lower eyelid surgery with scaring and a shortening of the lower eyelid is to combine a canthoplasty with a lower eyelid lengthening. This is best accomplished using a hard palate graft from the roof of the mouth to lengthen the eyelid from behind. Because the midface often contributes to these situations, definitive repair may also require placement of an orbital rim implant made from ePTFE to hold the weight of the cheek. You can see examples of this type of work at my website: www.lidlift.com/fixing/. The ultimate cosmetic results are excellent.
I don't have photographs of your eyes, so it is difficult to give you specific advice. As you know, lagophthalmos is an inability to fully close the upper eyelid. You did not tell us how you developed this conditions; I am assuming that you either had an over-aggressive blepharoplasty, a facial nerve paralysis, or possibly burns to the eyelid skin.
The reason that you have lagophthalmos is important to determine the right treatment. Scleral show is retraction or shortening of the lower eyelid creating excessive "show" of the lower white sclera. There are a variety of causes for scleral show, but it sounds like you either developed this after your canthopexy or it was a prior condition made worse by your canthopexy. These problems can be treated.
If you provide us with more details of your medical history, your symptoms and close-up photographs of your eyes, you will get better advice on your possible treatment options.
You have a complex situation here, but not impossible. I also recommend finding an eyelid specialist. Although most plastic surgeons do eyelids, some feel more comfortable treating complex problems like yours. If your surgeon doesn't feel comfortable, ask for a recommendation.
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Depends on muscles ability to close eyelid normally
These conditions can be corrected, but it depends upon the ability of the muscle function to be able to close the eyelid normally. There must be an underlying reason that a 28-year-old patient underwent a canthoplasty or canthopexy for which was not stated in the question. Scleral show can be corrected by multiple different procedures including mucosal skin grafting from the oral cavity to the inside of the lower lid and a re-suspension of the entire lower lid skin upwards and onto the lateral orbital rim.
Correcting lagopthalmos and lateral scleral showing
Unfortunately, this can be a difficult problem which may require several maneuvers to correct.
This may include a mucosal or Alloderm conjunctival graft for the inner lamella, complete arcus marginalis release with midface/ cheek lift, canthal surgery, orbicularis suspension, and even skin grafting, although can often be avoided.
If enough time has passed since the last procedure, you should consult with a qualified surgeon who is very experienced in this problem, and can show results, in my opinion.
Many options for lid lenthening procedures
There are many options for lid lengthening procedures from orbicularis release and volume filling to more complex procedures with implants and lateral canthal tightening. Explore many of them before chosing one, and I would avoid permanent implants if possible.