Can Infraorbital Rim Implants Help To Decrease Scleral Show?

Q: Dr. Eppley, I have a question about your stance on the ability of infraorbital rim implants to marginally effect scleral show on the lower lids. 

I’ve researched this topic quite a lot, and your name always pops up within discussions surrounding it. I’m a bit confused, though, as in some posts — whether it be on your blog or— you suggest that if orbital implants have enough vertical height, they can help drive up the eyelid slightly and reduce scleral show. However, it seems you also commonly suggest these days that any sort of vertical pushing from beneath is a flawed concept so far as changing lower eyelid position. 

Is it the case that sometimes it can work and sometimes it doesn’t? Is it that when it does work, the effect is very marginal and so wouldn’t be very perceptible? 

Interested in your insight on this topic. Many thanks!

A: CUSTOM infraorbital rim implants that saddle the rim and add vertical height can have a modest effect on reducing scleral show as there is a relationship between the bony infraorbital rim and the lower eyelid position. If a modest reduction in scleral show is all that is needed (1 to 2mms) then the implant alone may suffice. But in significan sclerla show with rounded lower eyelids and/or downturned outer eye corners, the implant will need to be supplemented with soft tissue management as well (spacer lower eyelid grafts and lateral canthoplasty) to have a very visible and sustained lower eyelid uplifting effect.

It is not a question of whether it sometimes works and sometimes doesn’t. You have to match the anatomic problem the patient has with the correct solution to treat it. All three techniques mentioned are tools to be used of which some lower eyelid reshaping needs only requires one while others requires all three.

Dr. Barry Eppley

World-Renowned Plastic Surgeon