NZb6Air
Kraken
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I have read a lot of retarded shit coming from low iq surgery copers like @piec @k99 (JFL at not having them muted btw)
Saying you should get lower eyelid retraction to fix lower scleral show i.e. thinking(noun) that is typical of noobs (soft tissue bro (they don't have the iq to imagine there's an entire system under the skin that affects the outside)
First of all how to tell you have lower scleral show?
Note : we're talking about 1 or 2 millimeters btw
According to Dr. Naini :
The eyelids cover the exposed anterior projection of the eyeball.
The upper lid is larger, more curved and rather more active than the lower¹. [...]
The superior most point of the curve of the upper lid margin is approximately one-third of an eye width from the medial canthus. The inferior most point of the gently arcing lower lid margin lies between the pupil and lateral limbus, approximately one-third of an eye width from the lateral canthus (Figure 12.11 ). The upper eyelid margin overlaps the superior iris limbus by 1 – 2 mm. There should be minimal or no scleral exposure between the lower lid margin and the inferior limbus; excessive scleral exposure below the iris is a sign of midfacial hypoplasia.
(Figure 12.11)
Again, here he's describing patients with malar deficiency and we can see they have notable lower scleral show
Again here we have a patient with Crouzon syndrome used to describe orbital hypertelorism, Crouzon syndrome patients have deficient maxillas
I quote him again :
"In a patient with normal midfacial morphology and in NHP there should be no sclera exposed either above or below the irides in a relaxed eyelid position and forward gaze. Increased scleral exposure above the lower eyelid and below the iris of the eye is a sign of sagittal upper midfacial deficiency due to retrusion of the inferior orbital rim (Figure 16.5)."
PS : it's also accompanied with nasojugal folds most of the time
Now that we know what is lower scleral exposure and its cause, where did the eyelid retraction surgery thing come from?
Because of people's propension to hold soft tissue surgeries in a more favourable eye (bone is scary). Eyelid retraction surgery has been an effective way to deal with eyelid retraction related to thryoid eye disease, basically TED swells and inflames the tissues around the eyes (including muscles² - ³ and fat (thus fat removal during OD aswell -- it's what Taban does at least), the peri muscles are enlarged⁴ bla.. bla bla this excessive tension weakens the orbicularis which makes the levator overact, etc.⁵
Since it's not even muh minimally invasive ( read more here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988987/pdf/TJO-12-12.pdf ) you have to be a good candidate for it which means your eyelids should be weak, thankfully I've made guide on how to determine that :
looksmax.org
So if they aren't and you have nasojugal folds then you have most likely an upper maxillary deficency i.e. retrusion of the infraorbital rim, therefore you have to fix it by getting infraorbital implants (and not fillers JFL https://looksmax.org/threads/filler-artificial-fat-implants-artificial-bone.992716/ )
Inb4 muh there's no results, it's literally well documented in the literature : Just open pubmed lil bro or some book
However if your scleral show is above 2 mms then you should combine it with fat grafts and then even lower eyelid retraction if it's even more severe BUT a fat graft/filler/LER WITHOUT an infraorbital rim implant WILL LOOK SHIT
¹Flowers RS. The art of eyelid and orbital aesthetics: multiracial surgical considerations. Clin Plast Surg 1987;14 (4):703 – 21.
²Cockerham KP, Hidayat AA, Brown HG, Cockerham GC, Graner SR. Clinicopathologic evaluation of the Mueller muscle in thyroidassociated orbitopathy. Ophthalmic Plast Reconstr Surg 2002;18:11‑7
³Shih MJ, Liao SL, Kuo KT, Smith TJ, Chuang LM. Molecular pathology of Muller’s muscle in Graves’ ophthalmopathy. J Clin Endocrinol Metab 2006;91:1159‑67
⁴Small RG. Enlargement of levator palpebrae superioris muscle fibers in Graves’ ophthalmopathy. Ophthalmology 1989;96:424‑30.
⁵Harrison AR, McLoon LK. Effect of hyperthyroidism on the orbicularis oculi muscle in rabbits. Ophthalmic Plast Reconstr Surg 2002;18:289‑94.
@greycel @onion_salad @truthhurts @Asspear @UZB_Strebl @chrishell @sb23
Saying you should get lower eyelid retraction to fix lower scleral show i.e. thinking(noun) that is typical of noobs (soft tissue bro (they don't have the iq to imagine there's an entire system under the skin that affects the outside)
First of all how to tell you have lower scleral show?
Note : we're talking about 1 or 2 millimeters btw
According to Dr. Naini :
The eyelids cover the exposed anterior projection of the eyeball.
The upper lid is larger, more curved and rather more active than the lower¹. [...]
The superior most point of the curve of the upper lid margin is approximately one-third of an eye width from the medial canthus. The inferior most point of the gently arcing lower lid margin lies between the pupil and lateral limbus, approximately one-third of an eye width from the lateral canthus (Figure 12.11 ). The upper eyelid margin overlaps the superior iris limbus by 1 – 2 mm. There should be minimal or no scleral exposure between the lower lid margin and the inferior limbus; excessive scleral exposure below the iris is a sign of midfacial hypoplasia.
Again, here he's describing patients with malar deficiency and we can see they have notable lower scleral show
Again here we have a patient with Crouzon syndrome used to describe orbital hypertelorism, Crouzon syndrome patients have deficient maxillas
I quote him again :
"In a patient with normal midfacial morphology and in NHP there should be no sclera exposed either above or below the irides in a relaxed eyelid position and forward gaze. Increased scleral exposure above the lower eyelid and below the iris of the eye is a sign of sagittal upper midfacial deficiency due to retrusion of the inferior orbital rim (Figure 16.5)."
PS : it's also accompanied with nasojugal folds most of the time
Now that we know what is lower scleral exposure and its cause, where did the eyelid retraction surgery thing come from?
Because of people's propension to hold soft tissue surgeries in a more favourable eye (bone is scary). Eyelid retraction surgery has been an effective way to deal with eyelid retraction related to thryoid eye disease, basically TED swells and inflames the tissues around the eyes (including muscles² - ³ and fat (thus fat removal during OD aswell -- it's what Taban does at least), the peri muscles are enlarged⁴ bla.. bla bla this excessive tension weakens the orbicularis which makes the levator overact, etc.⁵
Since it's not even muh minimally invasive ( read more here : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988987/pdf/TJO-12-12.pdf ) you have to be a good candidate for it which means your eyelids should be weak, thankfully I've made guide on how to determine that :
How to recognize lower eyelid laxity
As you know I keep saying lower scleral show is most of the time of bony origin (upper maxillary deficiency) which seems to be an unpopular opinion. This is how you test it¹: Test 1 : With your thumb and index pull the lower lid away from the eye (to the side) and then release it to see how...
looksmax.org
So if they aren't and you have nasojugal folds then you have most likely an upper maxillary deficency i.e. retrusion of the infraorbital rim, therefore you have to fix it by getting infraorbital implants (and not fillers JFL https://looksmax.org/threads/filler-artificial-fat-implants-artificial-bone.992716/ )
Inb4 muh there's no results, it's literally well documented in the literature : Just open pubmed lil bro or some book
However if your scleral show is above 2 mms then you should combine it with fat grafts and then even lower eyelid retraction if it's even more severe BUT a fat graft/filler/LER WITHOUT an infraorbital rim implant WILL LOOK SHIT
¹Flowers RS. The art of eyelid and orbital aesthetics: multiracial surgical considerations. Clin Plast Surg 1987;14 (4):703 – 21.
²Cockerham KP, Hidayat AA, Brown HG, Cockerham GC, Graner SR. Clinicopathologic evaluation of the Mueller muscle in thyroidassociated orbitopathy. Ophthalmic Plast Reconstr Surg 2002;18:11‑7
³Shih MJ, Liao SL, Kuo KT, Smith TJ, Chuang LM. Molecular pathology of Muller’s muscle in Graves’ ophthalmopathy. J Clin Endocrinol Metab 2006;91:1159‑67
⁴Small RG. Enlargement of levator palpebrae superioris muscle fibers in Graves’ ophthalmopathy. Ophthalmology 1989;96:424‑30.
⁵Harrison AR, McLoon LK. Effect of hyperthyroidism on the orbicularis oculi muscle in rabbits. Ophthalmic Plast Reconstr Surg 2002;18:289‑94.
@greycel @onion_salad @truthhurts @Asspear @UZB_Strebl @chrishell @sb23
