Can dermal fillers or Botox fix upper eyelid retraction caused by TED? (photo)

Question

I have Thyroid Eye Disease and Graves‘ disease. I went to ocular plastic surgeon and he diagnosed me and said that its only cosmetic problem at this point and TED is in inactive stage. My left eyelid is lower than the right one. I have heard of Botox or dermal fillers to correct the asymmetry? I went to consultation with cosmetic dermatologist and she suggested fillers.

C. Blake Perry, MD · Answer

Asymmetry of the eyelids from Thyroid Eye Disease typically responds best to surgical options. Filler and botox can certainly camouflage the asymmetry to some degree. I recommend seeing an eyelid specialist who deals with Thyroid Eye Disease.
Best of luck!

Mehryar (Ray) Taban, MD, FACS · Answer

Fillers will not change eyelid position which is affected by thyroid eye disease. Eyelid surgery is usually needed. Best to have evaluation in consultation by an oculoplastic specialist.

David Z. Gay, MD · Answer

Fillers and botox can be used with variable results in Thyroid Eye Disease. Filler doesn’t fix the underlying problem but can add volume to the lid making it cover more of the eye. The weight and volume of the filler can change the eyelid position. The results are not as predictable as surgery, but can be worth trying with someone experienced injecting in this area. Botox is even more unpredictable. It is very hard to get reliable results with botox. I only use botox in Thyroid Eye disease to drop the lid if the eye is getting too dry and leading to problems. It is a temporary solution while I plan surgery.

Jasmine Mohadjer, MD · Answer

There are several options to address your concerns without surgery.  Botox can be used in your upper eyelid to bring it down a little.  In the picture you posted, it appears that your left upper eyelid is higher than your right one.  However, you will have to try different doses to get the right one, and in fact, if too much is placed, your left upper eyelid may be too low as well.  So it will perhaps take a few treatments to find the right dose, and of course will need to be repeated every 3 months. As far as your left lower lid, it also appears to be retracted, and lower than your right lower lid.  We can see the white of your sclera under the eye.  Fillers can be used conservatively to bolster up the lower lid and raise in a couple of millimeters, which may be all you need.  These fillers can last a year or more in this area.  If you are unhappy with it, they can be dissolved. So there are definitely a few non surgical options to make you a bit more symmetric! Good luck!

Matthew Sniegowski, MD · Answer

To answer your question, yes, a filler can be tried on the left side. The challenge with using filler is that you need to try to get vertical elevation without adding bulk to the eyelid (which would look worse cosmetically). For eyelid retraction associated with thyroid eye disease your better option may be surgical repair of the retraction (even if you have to do this cosmetically)

Can dermal fillers or Botox fix upper eyelid retraction caused by TED? (photo)

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