lower eyelid surgery and space grafts

[homo_faber]

Background: Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. Objectives: To evaluate the efficacy of lower eyelid retraction surgery without internal graft in select cases. Methods: Retrospective analysis of patients undergoing reconstructive lower eyelid retraction surgery without internal graft, by one surgeon from 2013 to 2015. Surgical technique included transconjunctival lower eyelid retractor lysis, canthoplasty, and temporary tarsorrhaphy, with or without subperiosteal midface-sub oribularis oculi fat (SOOF) lifting and scar lysis. Eyelids with true lower eyelid middle-lamella shortage were excluded. Analysis included 17 surgeries (11 patients). Eight of 11 patients had undergone at least one previous lower eyelid surgery with resultant lower eyelid retraction and sclera show. Preoperative and postoperative photographs at longest follow-up visit were analyzed with standardized measurements. Patient satisfaction was recorded using questionnaire. Results: Etiologies of lower eyelid retraction included prior lower blepharoplasty, thyroid eye disease, and chronic facial palsy. All 11 patients (17 procedures) demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.2 mm (range, 1.6-2.8 mm). There was one case of mild overcorrection. The average follow-up was 7 months (range, 6 months-2 years). Midface lift was performed for 14 of 17 eyelids. Conclusions: This study demonstrates improvement of lower lid position after lower eyelid retraction surgery without internal eyelid spacer graft in select patients. Most patients in our study had undergone previous lower eyelid blepharoplasty and required midface-SOOF lifting. Background: Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. Objectives: To evaluate the efficacy of lower eyelid retraction surgery without internal graft in select cases. Methods: Retrospective analysis of patients undergoing reconstructive lower eyelid retraction surgery without internal graft, by one surgeon from 2013 to 2015. Surgical technique included transconjunctival lower eyelid retractor lysis, canthoplasty, and temporary tarsorrhaphy, with or without subperiosteal midface-sub oribularis oculi fat (SOOF) lifting and scar lysis. Eyelids with true lower eyelid middle-lamella shortage were excluded. Analysis included 17 surgeries (11 patients). Eight of 11 patients had undergone at least one previous lower eyelid surgery with resultant lower eyelid retraction and sclera show. Preoperative and postoperative photographs at longest follow-up visit were analyzed with standardized measurements. Patient satisfaction was recorded using questionnaire. Results: Etiologies of lower eyelid retraction included prior lower blepharoplasty, thyroid eye disease, and chronic facial palsy. All 11 patients (17 procedures) demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.2 mm (range, 1.6-2.8 mm). There was one case of mild overcorrection. The average follow-up was 7 months (range, 6 months-2 years). Midface lift was performed for 14 of 17 eyelids. Conclusions: This study demonstrates improvement of lower lid position after lower eyelid retraction surgery without internal eyelid spacer graft in select patients. Most patients in our study had undergone previous lower eyelid blepharoplasty and required midface-SOOF lifting. The author proposes that "routine" placement of lower eyelid internal spacer/graft may not be necessary during lower eyelid retraction surgery. The author proposes that "routine" placement of lower eyelid internal spacer/graft may not be necessary during lower eyelid retraction surgery.

Lower Eyelid Retraction Surgery Without Internal Spacer Graft

Download Citation | Lower Eyelid Retraction Surgery Without Internal Spacer Graft | Background: Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. Objectives: To... | Find, read and cite all the research you need on ResearchGate

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[homo_faber]

how long term stabble are space grafts? what happens if you get punched below the eye?

 

[Deleted member 439]

result looks similar to infraorbital implants?

 

[homo_faber]

result looks similar to infraorbital implants?

i dont think so, an implant would be bigger and is normally put lower then a spacegraft? i think the effect of an implant would be more comparable to the suborbicularis oculi fat lift technique

 

[Ocelot]

@streege you said you'd elab eventually on why spacer grafts are necessary

 

[Deleted member 439]

i dont think so, an implant would be bigger and is normally put lower then a spacegraft? i think the effect of an implant would be more comparable to the suborbicularis oculi fat lift technique

I admit this is not my area of expertise which is why i framed it as a question.
I thought vertical augmentation of infras can lower orbital socket size, which pushes the fat pads closer to the undereye and makes them appear more prominent

 

[Deleted member 439]

But the patients are all old ladies who have very little fat pads. Could it be that the doctor opted for fat gafts rather than implants for this reason?

 

[homo_faber]

I admit this is not my area of expertise which is why i framed it as a question.
I thought vertical augmentation of infras can lower orbital socket size, which pushes the fat pads closer to the undereye and makes them appear more prominent

https://looksmax.org/threads/is-the...mplants-and-infraorbital-rim-implants.240460/

not an expert myself, but most infraorbital implants doesnt seem to be placed on the rim bone despite the name suggesting otherwise. its rather on the same height. idk check out the linked thread.

 

[Blackgymmax]

Why is this even new. You guys have known taban for years and he does this in many of his almond eye surgeries jfl

 

[Blackgymmax]

Lower eyelid retraction repair surgey = multiple surgeries which includes
Different canthopexy procedures, spacer graft technique, orbital decomp etc.

 

[Blackgymmax]

i dont think so, an implant would be bigger and is normally put lower then a spacegraft? i think the effect of an implant would be more comparable to the suborbicularis oculi fat lift technique

But the patients are all old ladies who have very little fat pads. Could it be that the doctor opted for fat gafts rather than implants for this reason?

Instead of fat grafts they usually use a midface lift to try and push more fat around the eyelid. I dont know why fat grafts or transplants aren't used but in theory it would work as well. You could use infraorbital rim implants but its best when combined with a midface lift. Those 2 together will instantly give extreme lower eyelid support

 

[Belt]

@blackgym

Instead of fat grafts they usually use a midface lift to try and push more fat around the eyelid. I dont know why fat grafts or transplants aren't used but in theory it would work as well. You could use infraorbital rim implants but its best when combined with a midface lift. Those 2 together will instantly give extreme lower eyelid support

Do you think a mid-face lift that pushes the cheeks up can lift the lower eyelid? Do you know if there are surgeons who do medium face lifts with the purpose of lifting the lower eyelid?

 

[Blackgymmax]

@blackgym

Do you think a mid-face lift that pushes the cheeks up can lift the lower eyelid? Do you know if there are surgeons who do medium face lifts with the purpose of lifting the lower eyelid?

Yes butbyou need to have the bone support originally

 

[greycel]

Instead of fat grafts they usually use a midface lift to try and push more fat around the eyelid. I dont know why fat grafts or transplants aren't used but in theory it would work as well. You could use infraorbital rim implants but its best when combined with a midface lift. Those 2 together will instantly give extreme lower eyelid support

Think it's because the fat cells would still remain there, so if you gained weight again.. then you would face an issue of looking way too bloated (esp with the new fat cells being much larger).
I've heard of these midface lifts (like endoscopic midface lifts), don't you think that they look uncanny?
Might just go for a nano fat transfer to undereyes after vertical augmentation to correct hollowing.

Yes butbyou need to have the bone support originally

You think the bone support gain from implants will be sturdy?
When people age, their undereyes get recessed more so vertically, but also laterally. If it does, it could collide with eye, causing permanent vision loss no? As this rim is saddled on the bone itself.