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Dr Guy Massry, M.D.

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Novel Approach to Correcting Lower Lid Droop - Minimally Invasive Orbicularis Sparing (MIOS)

Dr. Guy Massry and Dr. Babak Azizzadeh, working together have developed a novel approach to correcting lower lid droop (eyelid retraction) in patients with facial/eyelid paralysis.

Beverly Hills, CA, March 29, 2012 --( Dr. Guy Massry, Beverly Hills Ophthalmic Plastic Surgery, and Dr. Babak Azizzadeh, Beverly Hills Facial Plastic Surgery, working together have developed a novel approach to correcting lower lid droop (eyelid retraction) in patients with facial/eyelid paralysis. They have called this the “Minimally Invasive Orbicularis Sparing (MIOS)” procedure.

In patients with facial paralysis (such as Bell’s palsy) it is not uncommon for the eyelid closing muscle (the orbicularis oculi) to be involved. In this setting, there is poor eyelid closure (eye remains open when attempting to close the eyes) and the lower lid tends to fall (retract). These can be disfiguring problems which are very challenging to correct, especially in a cosmetically pleasing way.

Numerous procedures have been described to correct the lower lid droop (retraction) inherent to eyelid paralysis. In all these surgeries the lower lid is both elevated and tightened (suspended). “Most of these procedures require the placement of tissue grafts from other parts of the body, unsightly skin incisions, disruption of the lateral canthus (the outer corner where the upper and lower eyelids meet) and surgical manipulation of the muscle of the lower lid - which is already weak and vulnerable to worsening weakness,” stated Dr. Massry.

In an effort to address the problem of lower lid retraction in a more anatomic and less traumatic way Dr.’s Massry and Azizzadeh have devised the “Minimally Invasive Orbicularis Sparing (MIOS)” surgery.

In this technique the lid is elevated from its internal surface (transconjunctival) by releasing and recessing the muscle which pulls the lid down (lower lid retractor), and tightened (suspended) without cutting the outer corner of the lid (canthus). The approach to eyelid tightening is from the outer upper eyelid crease (like cosmetic lid surgery). With these steps the only small (half inch) skin incision is buried in natural upper eyelid crease (not visible), and most importantly, the muscle which supports the lower lid (orbicularis oculi) is left undisturbed.

An example of a young man who underwent the procedure (see photo- On the right is his after surgery pictures at 6 months. While perfect symmetry can never be attained when eyelid paralysis occurs – this is a significant improvement and step forward in eyelid paralysis surgery.

This recent innovation is born out of a continuing effort by Dr.’s Massry and Azizzadeh to improve the field of Ophthalmic Plastic & Reconstructive Surgery and Facial Plastic Surgery. For more information on Dr’s Massry and Azizzadeh please visit and .
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