I have lateral rounding of the outer lower lid with scleral show at 23 years old. I'm pretty certain it's congenital. It gives me an appearance of a sad, tired person. I also have weak cheeks so it could be due to a lack of cheekbone structure. I notice when I push my cheeks up with my fingers that it dramatically improves the appearance of my eyes. My question is what is the best method to elevate my lower lids? Fillers/fat grafting/eyelid surgery?
Lateral Rounding of the Outer Lower Lid with Some Scleral Show?
Doctor Answers 3
Lateral rounding of lower lid
The rounding of the lateral outer lid is best addressed with a canthopexy procedure performed by an oculoplastic surgeon.
Lower eyelid retraction
Although you have a rounded appearance to your eyes, it is mostly due to lower eyelid retraction [your lower eyelid is too low]. This may or may not be related to your facial bony structure [weak cheekbones or eye socket bones], or it may be a just soft tissue related.
An examination in person can help tease out the underlying cause, and help solidify a surgical plan.
Lateral Rounding of Lower Lids
In order to adequately advise you, I would need to see a picture of your entire face, and examine you. Without that, I can only provide general advice.
There certainly are surgical procedures that can be done to alter the lateral canthal appearance - a canthoplasty. I would only recommend this if you are prepared for the way it will alter your appearance. The altered appearance of a canthoplasty can be substantial.
As you have suggested, it may be beneficial to trial some dermal filler and see if it can be used to achieve the appearance you want. If it doesn't work, at least the result will be temporary. There is a risk of blindness with injecting around the eyes, so I suggest you see an experienced physician in this regard, and ask them to use a blunt cannula to inject, not a needle.
Best of luck,
Asif Pirani, MD, FRCS(C)