Can canthoplasty alone fix mild/moderate lower eye lid retraction? (Photos)

Question

I don't like the idea of grafs. I assume that in some cases it is necessary. Hopefully this will be not my case. Can canthoplasty alone fix mild/moderate eye lid retraction? * I had lower external blepharoplasty done 7 months ago, always had some scleral show but now is more (retraction) . Tearing eyes as well * .

Kenneth D. Steinsapir, MD · Answer

First, appreciate that your issue is not as bad as some.  Lateral canthoplasty is a procedure that tightens the lower eyelid.  Your lower eyelid retraction is not the result of the eyelid being loose.  You lower eyelid retraction is do to scaring of the eyelid and motor dysfunction along the margin of the lower eyelid as a result of your prior surgery.  Surgeons incorrectly think this can be repaired by tightening the lower eyelid.  Unfortunately they are ignorant of the surface topology.  The shorten lower eyelid will find a new shorter path on the surface of the eye.  That path will be lower on the eye surface. Essentially lateral canthal tightening will pull the lower eyelid down.  This is the opposite of what you are looking for.  Regaining this 1 to 2 mm of lid position requires a substantial reconstruction.  You need more than a posterior spacer graft.  The purpose of the graft is not to push up the eyelid.  The purpose of the graft is to control the shape of the eyelid contour.  In my opinion to also need to have skin recruited into the lower eyelid.  For this I personally use a vertical mid face lift done at the time of eyelid reconstruction.  You can read about it on my website.  The surgery will help your appearance but the big reason to have this type of surgery is help restore eye comfort.

Fred G. Fedok, MD, FACS · Answer

The management of lower eyelid retraction is a complicated process that involves an accurate diagnosis of what anatomic situation is causing the retraction and then selecting an optimal surgical remedy.Your best approach should be for you to be seen by an experienced surgeon that deals with such problems.  These days there are credible facial plastic, plastic and oculoplastic surgeons that do this work.Seek a consultation, asses the pros and cons of exploring a surgical solution.You will be able to come to the best decision for yourself - good luck!Fred G. Fedok, MD FACS

John J. Martin, Jr., MD · Answer

A canthopexy or canthoplasty can help with eyelid retraction.  However it is not a simple procedure.  A graft is sometimes needed if you have either a deficiency of skin, or some internal scarring.  If the lid can not be elevated easily with the fingers, this indicates there is some internal scarring which may need a graft.  You should consult with an oculoplastic surgeon who can determine what would be the best approach for you.  From the pictures it looks like you have good movement in the lid, and enough skin to be able to lift the lid.

Grady B. Core, MD · Answer

This is a difficult situation. Your preoperative photo does not show any indications for surgery. However, this is a very poor photo and the doctor who had the opportunity to do a physical exam may have seen things differently. I assume he now wants to do a canthopexy to correct the lid retraction. This also will be based on his physical exam and your degree of lid laxity and retraction. As Dr. Martin pointed out there may be more than just the pexy that is necessary to correct the situation. I would get a few opinions regarding this before having surgery with either an occuloplastic surgeon or a board certified plastic surgeon who does a lot of eyes. Brent Moelleken is near you in Santa Barbara and is very experienced. Best to you.

Geoffrey Kwitko, MD, FACS · Answer

You will need vertical spacers along the whole length of the lower eyelid. Possibly a collagen graft at the inner eyelid surface can accomplish this but it depends on how much excess skin you have whether or not you will need a skin graft.  Hard to tell for sure without examining you.

Can canthoplasty alone fix mild/moderate lower eye lid retraction? (Photos)

Answers (6)

Answer: Canthoplasty alone to fix issues.

Answer: Canthoplasty alone to fix issues.

Answer: Probably not

Answer: Probably not

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Everything you need to know about Canthoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.

Can canthoplasty alone fix mild/moderate lower eye lid retraction? (Photos)

Answers (6)

Answer: Canthoplasty alone to fix issues.

Answer: Canthoplasty alone to fix issues.

Answer: Probably not

Answer: Probably not

Browse related questions

Recommended reading

Everything you need to know about Canthoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.