Download PDF
Facial Plast Surg 2015; 31(06): 633-644
DOI: 10.1055/s-0035-1568136
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Aesthetic Refinements in Patients with Prominent Eyes

Dirk F. Richter
1   Department for Plastic Surgery, Dreifaltigkeits-Hospital, Wesseling, Deutschland, Germany
,
Nina Schwaiger
1   Department for Plastic Surgery, Dreifaltigkeits-Hospital, Wesseling, Deutschland, Germany
,
Maria Wiedner
2   Department for Plastic and Reconstructive Surgery, University Clinic Graz, Graz, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
14 December 2015 (online)

    Permissions and Reprints

Abstract

The treatment of prominent eyes is still a challenging task. As well as the surgery, proper preoperative diagnosis differentiating between patients with and without Graves ophthalmopathy plays an important role. In functionally asymptomatic patients with Graves disease suffering from the aesthetic impairment of prominent eyes, the transpalpebral decompression by intraorbital fat removal technique has been proved to be reliable, effective, safe, and easily performed by a trained and experienced oculoplastic surgeon. This technique provides long-lasting results, leading to improvement not only in visual function but also in personal well-being and in the patient's social life, with a high benefit-to-risk ratio. The most powerful tool to treat the lower lid deformity and malar bags in patients without Graves disease is the subperiosteal midface lift. It shortens the lid–cheek junction and blends the retaining periorbital ligaments. Furthermore, it adds volume to the lower lid and gives a stable support. By the nature of the procedure, it also turns a negative into a positive vector. In experienced hands, Olivari's orbital decompression and Hester's midface lift are ideal options for the treatment of prominent eyes.

Keywords

prominent eye - orbital decompression - midface lift
 

  • References

  • 1 Codner MA, Kikkawa DO, Korn BS, Pacella SJ. Blepharoplasty and brow lift. Plast Reconstr Surg 2010; 126 (1) 1e-17e
    CrossrefPubMedGoogle Scholar
  • 2 Hester Jr TR, Douglas T, Szczerba S. Decreasing complications in lower lid and midface rejuvenation: the importance of orbital morphology, horizontal lower lid laxity, history of previous surgery, and minimizing trauma to the orbital septum: a critical review of 269 consecutive cases. Plast Reconstr Surg 2009; 123 (3) 1037-1049
    CrossrefPubMedGoogle Scholar
  • 3 McCord Jr CD, Ellis DS. The correction of lower lid malposition following lower lid blepharoplasty. Plast Reconstr Surg 1993; 92 (6) 1068-1072
    CrossrefPubMedGoogle Scholar
  • 4 Rohrich RJ, Ghavami A, Mojallal A. The five-step lower blepharoplasty: blending the eyelid-cheek junction. Plast Reconstr Surg 2011; 128 (3) 775-783
    CrossrefPubMedGoogle Scholar
  • 5 Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg 2007; 120 (5) 1367-1376 , discussion 1377
    CrossrefPubMedGoogle Scholar
  • 6 McCord Jr CD, Shore JW. Avoidance of complications in lower lid blepharoplasty. Ophthalmology 1983; 90 (9) 1039-1046
    CrossrefPubMedGoogle Scholar
  • 7 Hamra ST. Repositioning the orbicularis oculi muscle in the composite rhytidectomy. Plast Reconstr Surg 1992; 90 (1) 14-22
    CrossrefPubMedGoogle Scholar
  • 8 Pessa JE, Zadoo VP, Yuan C , et al. Concertina effect and facial aging: nonlinear aspects of youthfulness and skeletal remodeling, and why, perhaps, infants have jowls. Plast Reconstr Surg 1999; 103 (2) 635-644
    CrossrefPubMedGoogle Scholar
  • 9 Tepper OM, Steinbrech D, Howell MH, Jelks EB, Jelks GW. A retrospective review of patients undergoing lateral canthoplasty techniques to manage existing or potential lower eyelid malposition: identification of seven key preoperative findings. Plast Reconstr Surg 2015; 136 (1) 40-49
    PubMedGoogle Scholar
  • 10 Collar RM, Lyford-Pike S, Byrne P. Algorithmic approach to lower lid blepharoplasty. Facial Plast Surg 2013; 29 (1) 32-39
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Richter DF, Stoff A, Olivari N. Transpalpebral decompression of endocrine ophthalmopathy by intraorbital fat removal (Olivari technique): experience and progression after more than 3000 operations over 20 years. Plast Reconstr Surg 2007; 120 (1) 109-123
    CrossrefPubMedGoogle Scholar
  • 12 Olivari N. Transpalpebral decompression of endocrine ophthalmopathy (Graves' disease) by removal of intraorbital fat: experience with 147 operations over 5 years. Plast Reconstr Surg 1991; 87 (4) 627-641 , discussion 642–643
    CrossrefPubMedGoogle Scholar
  • 13 Hirmand H, Codner MA, McCord CD, Hester Jr TR, Nahai F. Prominent eye: operative management in lower lid and midfacial rejuvenation and the morphologic classification system. Plast Reconstr Surg 2002; 110 (2) 620-628 , discussion 629–634
    CrossrefPubMedGoogle Scholar
  • 14 Jelks GW, Jelks EB. The influence of orbital and eyelid anatomy on the palpebral aperture. Clin Plast Surg 1991; 18 (1) 183-195
    PubMedGoogle Scholar
  • 15 Clauser L, Galiè M, Sarti E, Dallera V. Rationale of treatment in Graves ophthalmopathy. Plast Reconstr Surg 2001; 108 (7) 1880-1894
    CrossrefPubMedGoogle Scholar
  • 16 Schiller JD. Lysis of the orbicularis retaining ligament and orbicularis oculi insertion: a powerful modality for lower eyelid and cheek rejuvenation. Plast Reconstr Surg 2012; 129 (4) 692e-700e
    CrossrefPubMedGoogle Scholar
  • 17 Flowers RS. Canthopexy as a routine blepharoplasty component. Clin Plast Surg 1993; 20 (2) 351-365 Review
    PubMedGoogle Scholar
  • 18 Jelks GW, Jelks EB. Preoperative evaluation of the blepharoplasty patient. Bypassing the pitfalls. [Review]. Clin Plast Surg 1993; 20 (2) 213-223 , discussion 224
    PubMedGoogle Scholar
  • 19 Yaremchuk MJ. Improving periorbital appearance in the “morphologically prone”. Plast Reconstr Surg 2004; 114 (4) 980-987
    CrossrefPubMedGoogle Scholar
  • 20 Hester Jr TR, Codner MA, McCord CD, Nahai F, Giannopoulos A. Evolution of technique of the direct transblepharoplasty approach for the correction of lower lid and midfacial aging: maximizing results and minimizing complications in a 5-year experience. Plast Reconstr Surg 2000; 105 (1) 393-406 , discussion 407–408
    CrossrefPubMedGoogle Scholar
  • 21 McCord C, Nahai FR, Codner MA, Nahai F, Hester TR. Use of porcine acellular dermal matrix (Enduragen) grafts in eyelids: a review of 69 patients and 129 eyelids. Plast Reconstr Surg 2008; 122 (4) 1206-1213
    CrossrefPubMedGoogle Scholar