Patients who have a “negative vector,” are prone to complications after lower lid surgery. Although the phrase was coined by a well-meaning, and no doubt intelligent surgeon, the term vector is grossly inappropriate, as would be noted in a review of any high-school physics text. It is intended to signify that the eyeball protrudes further than the part of the cheek-bone that supports it. This, in turn provides no support for the incised lower lid, and carries a significant risk of lower lid droop (ectropion and/or scleral show), with its attendant troubles of dry-eye, or wet-eye, or corneal irritation, or scarring, not to mention a poor cosmetic result. Preoperative dry eye, and absence of the protective Bell’s reflex, ectropion, entropion, scleral show, exophthalmos, whether associated with thyroid disease, or Graves’ all predispose the blepharoplasty patient to significant post-operative complications. Lower lid work carried out in high-risk individuals should include a complete disclosure of the possible problems, solutions, and pre-emptive and intra-operative preventive steps to minimize the risks. This may mean tightening of the lower lid, involving more invasive means combined with primary support of the septum with a substance like alloderm.
Jacob Gerzenshtein, MD, FACS,
A Board Certified Plastic Surgeon
