Which Incisional Approach is Best For Orbital Rim Implants?
Q: Dr. Eppley, my question is if one wants to raise the lower eyelids, instead of doing a canthopexy/canthplasty (as I am only 24 years old) can one do a orbital rim implant and still raise the lower eyelid to decrease scleral show?
I’m guessing this would push the lower eyelids up, remove the hollows and possibly increase cheek projection?
One doctor I spoke to said that placing orbital rim implants through the lower eyelids is the worst surgery as you have to cut everything up and then put the implants in and then reattach everything. He would stick a cheek implant through mouth all the way near the rim of eye and get the same result.
A: Orbital rim implants can potentially have a minor influence in some patients on pushing up the lower eyelids with the potential for decreased scleral show. But it is important to remember that the implants are on the inferior orbital rim bone which is below the actual lower eyelid. So I think this potential effect is more theoretical than actual in most cases.
When it comes to the incisional method for the placement of orbital rim implants, any doctor’s opinion will be colored by their experience. When a doctor has no experience doing this surgery through the lower eyelid approach, then for that doctor it is the ‘worst’ surgery. But in experienced hands the lower eyelid approach for orbital rim implants is both safe and effective.
Depending upon the design of the cheek/orbital rim implants, it is possible in some cases to go through the mouth for implant placement. But in many cases the orbital result may not be the same as with the lower eyelid approach. It is all about getting the implants in the right anatomic position.
Dr. Barry Eppley