Lower Blepharoplasty with Slightly Protruding Eyeball, How Can I Avoid Potential Complications?

Prominent Eyes can have several meanings, so my best advice is to ask the surgeon has had the benefit of examing you. Eyes can be prominent with conditions like Grave's disease, lid retraction or it can refer to the situation where the cheek bone is positioned posterior to the front of the eyeball.

WIth lower eyelid surgery a prominent concern is maintaining a normal relationship between the eyeball and the eyelid. This can help prevent dry eyes, problems with tear drainage and frank ectropion (eyelid malposition where the lid loses suport and rolls out, away from the eye - aka hound dog eyes).

More complications are seen with lower eyelid surgery when the lower eyelid is weak or posteriorly placed. Fewer complication occur with a conservative aproach (less removal or fat and skin). Modifying the procedure to include reinforcement of the normal lower eyelid support, or formal lid tightening when indicated. Post-operative support with steristrips or special stitches can also be helpful when indicated.

There are many options, and the most important way to minimize problems is to see a doctor who understands the procedure, who has experience with the procedure, and who is familiar with how to take care of you in case a problem develops. You need to know the risks of the procedure, but you do not need to know every nuance. On the other hand, your surgeon does. They need to explain what to look for, how to take care of yourself and what will be done if a problem develops. If you trust your surgeon, you will be more likely to do what they ask, and less likely to get into trouble. Best of luck to you.

It may not be necessary for the surgeon to do anything special with your procedure, other than to be very conservative with skin excision, and to utilize a transconjunctival approach (my preferred approach) to avoid any eyelid pulldown.  However, if there is weakness of the lower eyelid, then some surgeons will suggest a lid tightening procedure.

Your Plastic Surgeon was absolutely right.  The lower eyelid is not a very strong structure in the best of circumstances, and prominent eyes are far from the best of circumstances.  Patients with this condition are at higher risk of lower lid retraction or even ectropion due to the factors explained very well by Dr. Steins.  A conservative approach with additional support maneuvers isrequired.

Your PS is absolutely right that lower eyelid surgery on the so-called prominent eye is considered high risk for lower eyelid malpostion.  The appropriate saying is that "fool rush in where angels fear to tread."  The prominent eye is relative to lower orbital rim projection.  This lip of bone is where the weight of the cheek is supported.  With poor projection, the weight of the cheek is not well supported and pulls on the lower eyelid.  Many of the lower eyelid procedures fail to respect the lower eyelid support system.  The next result is a post-operative surprise where the lower eyelid ends up falling significantly as a consequence of the surgery.  There are maneuvers that can be performed to reduce the risk of this.  However some procedures actually make the situation worse.  For example many eyelid and midface surgeons attempt to shorten the lower eyelid in the hope of supporting it position after surgery.  This can actually worsen the pulled down position after surgery.  For this reason hight specialize techniques are needed to address these situations.

prominent eyes require certain precautions:


do not remove fat

consider repositioning fat

consider other fillers for volume

suspend the muscle but do not pull too tight

 

The best advise to give you regarding avoiding a complication is to see a surgeon who has done many of these types of procedures and/or repairs the complications of these procedures.  In this way, you will have done everything you possibly can. 

What he specifically was referring to was the risk of ectropion or lower eyelid malposition (pulled downward) after surgery. While this is a potential risk in any lower blepharoplasty procedure, certain eye conditions increase that risk. One of those risk factors is the prominent eye, which usually is the result of poor or weak bone support around the eyeball. Recognizing this condition before surgery allows your plastic surgeon to make adjustments to the lower blepharoplasty technique being used. This could include avoiding an external incision using a transconjunctival approach or adding a tendon tightening procedure with less skin removed from an external lower blepharoplasty approach.