It is only after the bulging is fixed by orbital decompression surgery that we can truly assess the damage to the eyelids from Thyroid eye disease. The eyelids may sit too high, too low, close incompletely, create the appearance of a stare, show persistent puffiness or skin excess, and sometimes all this can coexist.
The first step is to restore the eyelid position to normal. For the upper eyelid, blepharoptosis surgery corrects droopiness and retraction surgery corrects an eyelid that is too high. The same can be performed for the lower eyelid which can be combined with correcting the outer angle where the eyelids meet.
Once the eyelids settle into place, the residual bulge and skin excess can be corrected. In most cases, this is best undertaken with fat removal and skin reduction to restore a rejuvenated appearance.