Can a canthopexy be performed after a few weeks of Blepharoplasty to correct mild lower eyelid ectropion?
Canthopexy After Blepharoplasty?
Doctor Answers 7
A canthopexy is seldom the correct procedure.
First being only a few weeks after surgery, it is very difficult to know how you will actually heal. Some things get better and some things get worse in time.
Second, lets get our terminology correct. An ectropion is an outward roll of the lower eyelid such that there is a gap between the eye and the eyelid margin. This situation is relatively rare following lower eyelid surgery and would generally be caused by the surgeon removing too much lower eyelid skin in the setting of a very lax lower eyelid. The laxity of the lower eyelid should have been part of the surgeon's pre-operative assessment of the lower eyelid.
While it is possible that you have an actual ectropion, it is more likely that what you have is a post eyelid surgery lid margin contour abnormality with vertical inadequacy of the lower eyelid and possible lid margin roll. Outward lid margin roll results in visibility of the lower eyelid margin when you are looking directly at yourself in the mirror. This is not frank ectropion until the lid margin is pulled away from the eye. You may be confused by the terminology because many general and facial plastic surgeons refer to any eyelid contour change after blepharoplasty as "ectropion."
Canthopexy is a procedure that simply reinforces the strength of the lower eyelid ligament. Canthoplasty is a more robust procedure that shortens the ligament, repositions the canthal angle, and has some effect on the shape of the lower eyelid contour. However, neither of these procedures by themselves will correct a post blepharoplasty eyelid contour abnormality. For this, it is sometimes helpful to massage the eyelid upward while it is healing or place the corner of the eyelid on stretch with a supporting suture. I tend to avoid steroids because of the fat atrophy that can develop but 5-FU can sometimes be used to successfully modify the scar that is developing in the eyelid and likely to make your situation worse as healing evolves.
Ultimately if these measures are not helpful and after 6 to 12 months you are still not satisfied with the lower eyelid contour, post-blepharoplasty reconstruction with hard palate graft can be performed to restore the desired lower eyelid contour.
Patience after Blepharoplasty is essential
Dear Scared in FLA.,
The biggest risk to lower lid blepharoplasty is over resection of the skin or muscle resulting in pulling down of the lower lid reminiscent of a bloodhound. Some high profile stars in Hollywood have had these problems - Burt Reynolds, Jack Lemon, etc.
In these cases, the proper treatment is to wait until all the swelling has resolved and then treat the problem. For exmple, if too much skin has been removed then replace it with a small skin graft. If too much muscle was removed then, lift the muscle off the cheek to replace the muscle.
In some cases, the ligaments that hold the eyelids tight will stretch. This will act similar to what I have described above. A canthoplasty or tarsorrhaphy are the techniques that improve this problem. The key to a good canthoplasty is to make the outer angle of the eyelid look natural - the lower lid tucks under the upper lid as they meet in the outer corner of the eye. If it does not look like this then it looks fake!
But for you at two weeks after surgery, The swelling that is part of surgery can make you look like you have the problems described above. You need to wait at least 8 weeks before you run to have more surgery. In the meantime, you can perform exercises that help to improve the problem. The two I like best are 1- squeeze your eyes tightly together and hold for 5 seconds, repeat 5 times , three times a day. 2- use your index finger to gently press on the outer corner of your eyelid to lift an release the edema fluid.
I hope this helps.
Wait 4-6 months before canthopexy to correct ectropion
Canthopexy can often be used to correct ectropion or scleral show after Blepharoplasty.
However, I would not do a canthopexy until I was certain that you had an ectropion and would wait 4-6 months after your surgery.
If you have scleral show or ectropion in the immediate post operative period (the first 3-6 weeks), there are many measures that can be taken to stretch the lid and bring the lower eyelid into a proper position to protect the eye.
If you have a severe ectropion immediately after Blepharoplasty, I frequently use a small temporary stitch to close the outside corner of the lower eyelid with the upper eyelid-this is called a temporary tarsorraphy, and can be left in for a few weeks, while the lid loosens and swelling subsides.
If you just have scleral show and no exposure problems with your eye, then steri-strips/small tape strips can be used to tape the lower eyelid upward and to the side to pull the lower lid up.
In addition, strectching massages of the lower eyelid, pulling the lower eyelid up and out to the side towards your hairline can stretch the lid and help a developing ectropion.
As the surgical swelling subsides and the lower eylid tissues relax, the ectropion often improves over the first 6 weeks.
Be sure to keep your eyes moisturized with lubricant drops so that the eye does not become dry.
This is a very important issue so make sure you see your doctor soon.
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Too early for surgery
You need to give the tissues a chance to heal, and the swelling to resolve. You should focus on conservative (i.e., non-surgical) techniques to resolve the problem. Thes include massage, taping, and possibly oral steroids. All of these should be under the direct guidance of your plastic surgeon.
Sometimes canthopexies are a big help and even necessary for lower lid malposition. But be careful since it can also exacerbate a problem if the correct diagnosis is not made. Sometime your lower lid needs more than a canthopexy or may need support from below the eyelid and a canthopexy may actually pull the lid lower as you try to tighten it. Also, cosmetically it is diffiucult to achieve true and exact symmetry with canthopexies so be prepared for some asymmetry.
Wait. Your surgeon should always evaluate your lower eyelid stregth before the surgery
You should definitely wait at least six months prior to considering a revision surgery. There are a range of conservative measures that should be considered by you and your surgeon during that period of time. These include taping, massage, and possibly a temporary suture to help support the lower eyelid.
The robustness of your lower eyelid support should have been a very important part of your pre-surgical evaluation. This is not to say that your surgeon did not consider this issue. All surgeons that have done a significant number of blepharoplasty surgeries have encountered patients in which the impact on lower eyelid position has been greater than they might have expected. The key thing is to make sure your surgeon is taking a detailed history and physical exam prior to surgeon.
Wait 6 months before revisions
Ectropion is a result of many things during lower lid blepharoplasty, removal of too much skin, scarring of the orbital septum or damage to the muscle. However, during a normal blepharoplasty we do things that we know will create ectropion so other things must be done to counter this.
A canthopexy is part of the procedure to fix ectropion. The second thing that must be done is elevation of the midface to reduce the downward forces on the lower lid.
However, you're too early for any of this. You should be doing massage of the lid and taping to start. After this your surgeon may consider steroids to help. If it's not better in 6 months then look into surgery.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.