Can a Lower-lid Retraction Be Improved by Performing a Mid-face Lift Through the Mouth?

You need to be careful about midface lifts that depend on suspension to the bone around the eyelids. Talk to your surgeon about the risks of lower lid scarring and pulling down. A safer route may be through more of a facelift approach with incision in the hairline.This approach will not impair the eyelid.

Yes and yes.  The trans-oral approach is a great one and this mid-face lift can support he lower eyelid complex.  Can't tell you much more than that without a little surgical history and a photo.  I'll still need some suspension of the mid-face complex once it's elevated through the mouth and that can be done without cutting the lower eyelid skin.  It can be done via an upper lid incision or the temporal hair tuft.

 

Best of luck

Chase Lay, MD

Lower lid retraction can be caused by several mechanisms.

The lower lid is composed of three layers:

1: Skin or anterior Lamella

2: muscle or middle lamella

3: conjunctiva and lid retractors or posterio lamella.

Any shortage of these layers or scarring of these layers can cause lid retraction and the treatment is different for each cause.

The treatment is very complex and depend on appropriate diagnosis, and may require multiple steps to correct the original cause and another procedure (done at the same time) to support the repair.

The surgical execution is also very important for a successful repair. May require a skin graft , or an acellular graft or in complex cases a cartilage graft. Plus a canthopexy or even a canthoplasty.

From your question it is not clear if the lower lid retraction was a complication of your previous Blepharoplasty and Canthopexy OR was your lid retraction a complication of the procedure.

Lid retraction is a complex problem which is caused by multiple factors involving the three layers (lamellae) of the lower lid. Outer lamelar (skin) scar and shortage can cause it. Middle lamellae (muscle) issues can cause it. Inner lamella (septum) issues can cause it. Or combination factors can cause it such as scarring of the lower lid, shortage of lower lid soft tissues and down pulling of the affected lid. Each contributing or causing factor needs to be SPECIFICALLY corrected. You may require 
- a Canthoplasty
- addition of a spacer to the lower lid to support the cartilage support - tarsal plate
- vertical midface lift to reduce inferior cheek pull
- addition of skin to the lower lid (graft or flap of skin from the upper lid)

The best treatment would depend on YOUR specific cause. You should get a second opinion from experienced surgeons and go with the one you trust the most.

Good Luck.

 

I do not know how to answer this because I would do either a canthopexy or tarsoraphy and have usually been able to solve all problems without any significant scars. I would suggest seeing a very experienced occuloplastic surgeon and get the lid retraction fixed.....worry about the face work at a later date.

 

  No, IMHO.  Augmenting or filling in the anterior cheek will not increase the vertical height of the lower eyelid which is what may be the issue with the lower lid retraction.  These are isolated and separate aesthetic units (cheeks and loer eyelids) that should be addressed separately.  An occuloplastic surgeon should be able to tell you if you need additional vertical height to the lower eyelid.  

  Cheek Implants or fillers like Perlane or Radiesse can be used to fill or augment the cheeks.  Lifts of any kind, IMO are reserved for removing excess skin and loose SMAS over the face....not to push up the lower eyelid, which to me seems not plausible.  Be sure your plastic and cosmetic surgeon understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face.