Lower blepharoplasty - Canthopexy and risk of eyes looking smaller.

The reason general plastic surgoens perform canthopexy as a routine part of lower blepharoplasty, is that they perform the surgery through an lower eyelid incision below the lower eyelid lashes. This surgery cuts through the motor nerve that supply the muscle along the edge of the lower eyelid.  That is a very bad thing because it is this muscle that is responsible for holding the lower eyelid against the surface of the eye.  The canthopexy tightens the lower eyelid and tends to partially compensate for the motor damage to the orbicularis oculi. A canthopexy can distort the eyelids shape or it can have a minimal effect on the eyelid.  A better question: is it necessary to have a transcutaneous lower blepharoplasty?  Do you need a transcutaneous lower blepharoplasty?  An alternative is to perform the surgery from behind the lower eyelid using a method perferred by oculoplastic surgeons. Of course an even better question is do you need a lower blepharoplasty at all?  There is no substitute for getting a diversity of opinions.

Canthopexy is not standard and usually not necessary during lower blepharoplasty IF blepharoplasty is performed using transconjunctival technique however there are exceptions. I need to evaluate your eyes to give you definite answer. See following link.

Thank you for your question.  In my experience, when done correctly, a canthopexy does not change the shape of the eyelid at all.  But if the canthopexy stitch is placed too high, then the lid can have a slanted appearance and the eye will look smaller.  I would ask to look at before and after photos of other patients your surgeon has done canthopexys on.

A canthopexy is used for a lower bleph when the patient is at risk for a droopy lower eyelid after surgery. If done correctly, it is not expected to make your eye smaller or shorter looking but rather helps your eyelid hold its natural almond shape. Sometimes swelling immediately after surgery can give the false appearance of a smaller eye. There are many anatomical and functional considerations when deciding if a canthopexy is needed and therefore it is best to have an in-office examination to review your options and the pros, cons, and risks of each. Hope this helps!Johnson C. Lee, MD Plastic Surgery@drjohnsonlee

Most plastic surgeons will do something to support the lower lid if they believe it is at risk for ectropion (pulling down, resulting in show of the white sclera toward the outer corner of the eye). A few ways to mitigate against this complication include:1. Conservative excision of skin and being very careful with handling of the eyelid muscle and orbital septum, layers that provide support and strength to the lid2. Supporting the lid with a small canthopexy suture - there are many individual preferences on how to do this - in order to support the outer corner tissues against something solid like the bone. If done judiciously, like with a single support suture and not too tight a "sling" on the tissues, it does not usually change the shape of the lid at all.3. Being more aggressive with a canthoplasty, where the corner of the lid may even be divided and some extra tissue taken out, with the lid margin tissues used to support the angle of the lid. This is usually only required when patients either have preexisting laxity or as a correction to ectropion that has already occurred from prior surgery

It is not standard to do a canthopexy during lower lid blepharoplasty. Your surgeon should evaluate you lower lid extensively during your pre-operative visit to determine if the lids need extra support. Lower lid surgery done with a transconjunctival or "no scar" approach rarely needs a canthopexy in the majority of patients. I think its always a good idea to see different surgeons and get multiple opinions. Make sure you seek out doctors that have extensive experience or that specialize in eyelid surgery. 

Hi and thanks for your question.  It all depends on how tight your surgeon makes your canthopexy but if you've been recommended one, then you're probably going from having a loose lower eyelid to a normal one.  If this is the case it shouldn't change the size of your eye opening much.  Hope this helps!

Canthopexy is common after eyelid surgery. It's often done after trancutaneous (through the skin) or transconjunctival (through the inside of the eyelid). It depends on the laxity of the lower lid. I can make the eye smaller but that is not common in my experience. It is more common with canthoplasty. Consultations are helpful to determine exactly what you need and details of the risks. Best wishes.

A lateral canthopexy is a tightening of the lateral canthal tendon using a suture.  It can be used to raise the lower eyelid if it has become pulled downward giving it a nice appearance.  It can also be used to support the lateral corner of the eyelids, so if lower eyelid skin is removed that the lower eyelid margin does not get pulled downward or become ectropic (turned outward).  During some of my cases I will also pull the lower eyelid/cheek junction (+/- midface) through an upper blepharoplasty incision or an incision at the lateral raphe area of the crows feet to also bring up the lateral (outside edge) portions of the eyelid and cheek junction to help smooth the lower eyelid groove and sometimes to help with malar mounds (festoons).  It is a common practice to have a canthopexy done with lower eyelid surgery.  Rarely the eyes can become a bit smaller, but this is more common with canthoplasty where the outer corner of the eyelids is cut and/or a portion of eyelid is removed.  This is done typically for more severe forms of eyelid retraction/ectropion than most cosmetic cases need.  I hope this is helpful.  Best regards.  I've attached a link showing a patient I had to help revise from another surgeon because of too much skin removal from her lower eyelid that had inadequate eyelid canthal support on her left side .  

Hi Sara, greetings from the UK! No a lateral canthopexy shouldn't make your eyes look smaller if done properly. These procedures are called different names by different surgeons and the technique differs slightly. However most lateral canthopexy/ canthoplasty procedures have the primary effect of addressing horizontal laxity of the eyelid during a lower lid blepharoplasty to prevent any subsequent downward graviatational tension on the eyelid resulting in postoperative ectropion or retraction (round eye syndrome). I always say to my patients to think of the eyelid a bit like a washing line. As you get older that washing line can become a bit slack. Lower lid blepharoplasty surgery can cause increased downward pull on that washing line causing it to bow downwards (retractions). By tightening it horizontally the risk of this problem.

bw
David