9001 Wilshire Blvd, Suite 305, Beverly Hills, CA 90211



Note this case contains graphic images from surgery.

Chief Concern: This 28-year old has a history of childhood thyroid eye disease. She had orbital decompression at the Jules Stein Eye Institute as well as several other eyelid procedures. However, she has difficulty closing the eyelids.

Diagnosis: The patient had a profound benefit from her prior orbital surgery. However, she manifests poor projection of the inferior orbital rim. Consequently there is poor support for the lower eyelid and cheek. The lower eyelids hang below the curvature of the eyes. This prevents the eyelids from meeting upon lid closure.


542b1a4c40ca5The inferior orbital rim needs to be built up to support the cheek, which is vertically lifted onto the implant used along the orbital rim (Figure 2).

542b1a4f58b26The midface is exposed through a swinging eyelid approach (Figure 3).

542b1a51df471The implant is inserted and fixed to the orbital rim with microscrews (Figure 4).

542b1a54a153aThe cheek soft tissue is then vertically elevated to the top of the implant and fixed with stitches (Figure 5).

542b1a5743845Hard palate graft is harvested from the roof of the mouth and used behind the lower eyelid to help lengthen it (Figure 6).

542b1a59d54c7The lateral canthus is then resuspended and the skin is closed (Figure 7). Because the eyelids are immobilized and patched closed for a week to permit healing, only one side is done at a time. The other side was done 10 days later.