I had lower eyelid surgery with canthopexy two years ago and now my eyes are rounded, sagging, dry and irritated. Need expert opinions on whether I have lower lid retraction. Also, wondering if it is ectropion. I don't like the look of my lower eyelid margin rolling forward. Will a canthoplasty put the margin back against my eye or will it still look everted even with this procedure? I am not willing to go back to my original surgeon for advice. Any opinions and advice would be greatly appreciated.
Will a canthoplasty put the margin back against my eye? (photo)
Doctor Answers 2
Proceed carefully is my advise.
You do not have lower eyelid ectropion as far as I can tell from these photographs. You do have post surgical contour and lid positional changes associated with the prior surgery. This includes a lid margin rotation from loss of skin and scaring just below the eyelashes from the lower eyelid surgery. You may also have a disinsertion of the lateral canthal tendon but this is not well documented in the photographs you have provided. You asked if a lateral canthoplasty will correct your issues. The answer is that alone, canthoplasty does not have the power to correct the visible issue present in these photographs. For this I rely on using a hard palate graft for the purpose of shaping the lower eyelid contour and facilitating a lid margin roll correction. A physical examination is needed to determine if skin is needed in the front of the eyelid. If that is the case, I generally will perform a vertical midface lift over a hand carved orbital rim implant. My rationale for this is detailed in my publications. If one were to simply perform a canthoplasty, there is a substantial risk that the lower eyelid shortening will simply pull the eyelid margin under the curvature of the globe making the eyelid position worse.
Will a canthoplasty put the margin back against my eye?
If there is an actual deficiency of tissue in the vertical dimension, then you will need something else. If you have laxity of the lower lid, then a canthoplasty can be utilized. An exam would be necessary to sort this out. Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA
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