How Can My Prominent Eyes Be Fixed?

Q: Dr. Eppley,Thanks for taking the time to answer prospective patient questions! I have congenital prominent eyes and 1mm of inferior scleral show. Would lower lid retraction repair with a graft reduce my staring/occasional bug eye look at rest? When I smile or squint, my eyes look much better. However, I’m also wondering if I have a negative orbital vector, and whether this would be the best procedure for long term durability or if I’d be better off with infraorbital implants (if I were to only do one). If a graft- would you you use material like tarsal, hard palate, etc.? If implants, what would be the estimated cost for standard vs custom? Thanks!

A:Thank you for your inquiry and sending your pictures. Quite frankly you have a severe negative orbital vector what I would classify as a type III which is just about as severe as it gets. This fundamentally means this is a skeletal problem of which the live retraction is just a symptom of it. Therefore isolated eyelid surgery alone is the equivalent of putting a Band-Aid on the real problem and its effects would be very modest at best and probably not well-maintained. The correct approach is custom infraorbital-malar implants with lateral canthoplasties and lower eyelid spacer grafts.

Dr. Barry Eppley

Plastic Surgeon