Tightening the Outer Corners of the Eyes with Blepharoplasty?

I am planning to have a face lift with both upper and lower blepaharoplasty. I have dry eyes which I am concerned with that may have been a result of a previous blepharoplasty. My eyes are big and they also somewhat pretrude slightly, but are not unsightly. My surgeon says that he can tighten the outer corners of my eyes during the blepharoplasty to prevent futher dryness. Is this possible, and if so, will I look different?

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16 Doctor Answers | Asked by Page in Santa Barbara, CA

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Eyes will look different

Before undergoing a canthoplasty or canthopexy to reduce dry eyes, one should check with their ophthalmologist about placing silicone plugs in the tear ducts to gain more tears in the eye itself. Other eye drops prescribed by an ophthalmologist can help with dry eyes. Tightening the corners of the eyes will change the shape of the eyes to more of an almond shape, which may help a little bit with the dryness. Your eyes will look different, especially for the first month.

Blepharoplasty and Dry Eyes

Thanks for your questions Page - In my practice, we perform upper and lower blepharoplasty, and a careful history about dry eye must be obtained. The issue is that blepharoplasty can make eye dryness worse and interfere with your ability to protect your eyes, causing complications that can be as serious as blindness. The fact that you note you have some prominent globes increases possible complications. For patients with multiple risk factors, we typically employ several tests to... more

Be careful

Your surgeon must evaluate your orbital anatomy very careful. While in general tightening the lower eyelids (i.e. canthopexy or canthoplasty) is designed to prevent ectropion or scar contracture of the lower lid that may result in corneal exposure, it will usually produce a more upward slanted look (i.e. exotic, Asian, cat-like, etc.) and can also make things worse if you have what is known as a negative vector alignment. Here, the tightening can cause the lid margin to slip lower under the... more

Robin T.W. Yuan, MD

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Beverly Hills Plastic Surgeon

Corner of the eye surgery

The eye shape can and should be addressed when a lower blepharoplasty is performed. Often, the problem occurs during a first blepharoplasty, when skin is removed from the lower eyelid. This causes pulling down of the eyelid and rounding of the eye. In some patients, theyr eyeball (globe) is prominent, and protrudes out of the bony socket. Both of these conditions can cause dry eye by too much rounding of the eye and too much exposure of the very sensitive cornea, the lining of the eyeball... more

More than just the eyes

Page, Your situation is a very complex one, in which your dry eye syndrome may be worsened if the wrong procedure is done and may be improved if the correct procedure is performed. It sounds as if your surgeon is familiar with the issues that your present eye condition creates. However, the terminology of a repeat lower blepharoplasty concerns me. He may be using that term as a generic for your real requirement of lower lid repositioning. Be sure he/she is a board certified plastic... more

You are at very high risk for problems with your eyes.

To Page, Hi. You should consider leaving your eyes alone. Consult with an oculoplastic sugeon. You list a number of risk factors and could easily end up worse, both cosmetically and medically. I have seen this over and over. If you do have surgery, it sounds as if you need more than just tightening the corners. You probably need a full fledged Canthoplasty, which may raise the corners of your eyes, at least temporarily.

A canthopexy is a good way to approach your problem. That is probably what your surgeon wants to do.

Your problem is actually quite common. With time, the attachment of the lower eyelid to the bony rim of the eye laterally stretches, particularly if your eyes protrude slightly. This stretching changes your eye shape from almond to round. Tightening the attachment can restore the shape. The procedure is called a canthopexy. When a patient's eyes protrude somewhat, the early shape after surgery shows a steeper slope than will finally be present, so some patient is called for while this... more

"Tightening the corners" is a common practice

Page, It sounds like your surgeon is planning to perform a canthopexy or a canthoplasty. In either case, the lateral canthus (corner of the eye) is tightened. This is often performed during blepharoplasty to tighten up the lower lid. It can change the angle of the eye, but this is dependent on the level at which your surgeon secures the corner stitch. Just talk with your surgeon beforehand to make sure you are both on the same page. Good luck with your surgery.

This canthopexy may help with dryness

Your dryness is probably related to the first surgery and it sounds like your proptotic or protuding eyes caused it. Another blepharoplasty might help with the tightening of the lower lid, but it is not a guarantee. Sometimes a secondary bleparoplasty can make the dryness worse. Make sure you spend a lot of time discussing this to your satisfaction with your surgeon.

Reading between the lines

In an effort to read between the lines: Your eyes protrude somewaht - this is a red flag for many different eye problems. First you are at risk for retraction/pulling down of the lower lids in any surgery of the lower eyes. The tightening procedure on the corner of your eye may not work as well on you because of the protrusion. Finally, the protrusion may suggest that you have an underlying medical condition (Grave's disease) that may require furhter evaluation. You eyes are already wide... more