2 weeks post op - Canthopexy failed? Or too soon to tell?

15 days ago, I had upper bleph for saggy skin + canthopexy to fix 1.5mm inferior scleral show (both issues caused by Graves Eye Disease) done by oculoplastic surgeon. Swelling mostly gone now but scleral show still there maybe slightly reduced. Any chance lower lids will come up at all during the next few months or is this basicly it? Could it get worse as stuff heals/relaxes? Would taping, massage or squint exercises help, or will I need a 2nd canthopexy or other revision surgery? 32 y/o female

Doctor Answers 2

Difficult to answer without photos but...

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In general, after any surgical procedures, the swelling and bruising will distort tissues for few weeks; so give it a bit more time before considering a revision. Saying that, a canthopexy is usually indicated for scleral show  due to lower eyelid laxity. In your case, the scleral show is due to exophthalmos (protrusion of the globe) and maybe an orbital decompression would be the way to go. 
Hope it helps! 

No photo so please recognize that these are general comments.

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Canthopexy and canthoplasty lack the ability to correct inferior scleral show particularly in the setting of a prominent eye or relative eye prominence which is seen when there is poor inferior orbital rim projection.  These procedures are best to help a lax eyelid.  Due to the geometry of the eye, tightening the lower eyelid with these procedures can actually pull the lower eyelid below the curvature of the eye and make the inferior scleral show worse.  Definitive treatment involves adding projection to the orbital rim in the form of an implant.  I prefer hand carving an ePFTE implant for this purpose and vertically lifting the cheek up onto the rim implant.  This has the effect of recruiting more soft tissue into the lower eyelid space.  The effect is to take the weight of the cheek off of the lower eyelid.

Regarding your recent surgery, it is hard to comment definitively without the benefit of see your photos or examining you.  It is likely that things will improve as you are only 2 weeks out.  However, I think it is improbable that the lower eyelid will come further up.  If you do need revision, you will need an approach that is much more comprehensive than simply repeating the fail canthal surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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