What Is The Best Treatment For My Prominent Eyes and Droopy Upper Eyelids?

Q: Dr. Eppley,Hello, I am based in London and have nearly exhausted my list of potential oculoplastic surgeons following a few consulation.

I’ve had recommendations for the following combinations : bilateral ptosis repair , lower lid retraction with hard palate graft, lateral tarsal strip.

Orbital decompression , lower lid retraction, bilateral ptosis, canthoplasty

Infraorbital implant , bilateral ptosis , lower lid retraction.

The surgeons seem to disagree and I am considering travelling to the states for treatment . Would you be able to tell me if you think you could help?

I don’t like the bulging/prominent eyes or the droopy eyelids.

Thank you for your time

A:These various recommendations are not as different as they may seem. It is more about the variations in how to treat the 2 obvious eyelid situations you have, mild upper eyelid ptosis and more significant lower eyelid retraction….with the underlying skeletal issue of an infraorbital rim deficiency. (which is one reason  you have lower eyelid retraction)

The eyelid ptosis correction recommendation is a uniform one across the board. The ‘debate’ is in how to treat the lower lid retraction, specifically the ‘eyeball protrusion’ part of it, and the only controversy is whether it is better to drop the eyeball deeper into the orbital box (orbital decompression) or build it out the deficient infraorbital bone. (implant)  Both are different ways to try and help the lower eyelid retraction repair work better.  Most oculoplastic surgeons are going to recommend orbital decompression because that is a procedure in which they are more comfortable performing and it is an historic one in their toolbox so to speak. (doesn’ t necessarily mean it is the better procedure, just one in which they are most familiar) Building out the infraorbital bone is the opposite approach of which a custom infraorbital implant design is the superior implant method to do so. You choose this approach if you prefer the lower eyelid change as seen in the attached image.

Dr. Barry Eppley

World-Renowned Plastic Surgeon