Canthopexy Vs Canthoplasty to Correct Blepharoplasty Result?

Question

Can a canthoplasty be better than a canthopexy to correct a lower eyelid mild ectropion after a few weeks of a Blepharoplasty? And what other support is needed to help correct the damage?

Kenneth D. Steinsapir, MD · Answer

Dear Scared
You posted another variation of this question yesterday.
Obviously you are concerned about what is going on.  Ask yourself if you are unhappy with the way your surgeon is addressing your concerns.  If you are lacking confidence in his attitude or approach, it is appropriate to seek a second opinion.  I recommend that you start by asking him to arrange a second opinion.  This will undoubtedly be someone friendly to your surgeon.  However, often the second opinion is someone the first doctors trusts and respects.  This second doctor may have some input that will be helpful to your surgeon that will help with the immediate management of your eyelid issue.  This is more productive that seeking out a second opinion on your own which may not prove to be helpful and is likely to result in a break down of your relationship with your surgeon.  
If for some reason, you are not happy with the second opinion, I would strongly recommend that you consider seeking the opinion of a University based eye plastic surgeon.  These tend to be individuals who are extremely busy.  They won't be in directly competition with your surgeon and again they may be able to provide input regrading the management of your issue or alternative take over your care should this be necessary.
You are early out from your surgery.  Please do not talk yourself into an early revisional surgery for this particular problem.  Time and nonsurgical measures will help you now.  If after 6 months you are having issues, then is the time for revisional surgery and again the answer will not be a canthopexy or canthoplasty.  Without even seeing your photos, this is not going to fix the problem you are describing unless the proposed surgery is a canthoplasty combined with a reconstructive procedure to restore the vertical height of the eyelid.

Richard D. Gentile, MD · Answer

Lateral lid tighteninig can be accomplished in several different ways. For mild cases of lid laxity a canthopexy or muscle tightening procedure may be adequate to correct the lid laxity and malposition. If the lid malposition is severe then a canthoplasty such as a lateral tarsal strip may be necessary.

Christopher L. Hess, MD · Answer

It is not uncommon to have mild ectropion a few weeks after surgery, especially if extensive work was done.  So first don't do anything for 6 months.
With that said, if you still have ectropion after that time there are several things that must be done.  First I would do either a canthopexy or canthoplasty but that is dependent on what was previously done.  Second I like to plicated or tighten the obicularis muscle.  Finally, you must support/elevate the cheek.  This remove the downward force on the lower lid.
For now massage and possibly taping can help.  Sometimes early on a small amount of steroid is beneficial.

Robert T. Buchanan, MD (retired) · Answer

At 2 weeks what you have is a lot of swelling. The weight of that pulls the lid down occasionally. This generally creates what is called scleral show, not ectropion. At this point, the treatment is massage (up & lateral) of the lid. This will usually go away in several more weeks. You also need to make sure that you are not doing anything to worsen the problem, such letting your glasses rest on the lid. If this is an ectropion, eversion of the lid margin, then you do have a problem and need toe see a qualified plastic surgeon that specializes in repair of eyelid problems. You will also need to see such a qualified individual if significant scleral show persists beyond another few months and is bothersome. This is because you my need release of the lid and grafting. You will also, at that time, need a canthoplasty (or possible canthopexy). DO not, however, opt for either now.

Brooke R. Seckel, MD, FACS (retired) · Answer

Canthopexy is a less complex and safer procedure to tighten the eyelid and improve lid position and shape after lower eyelid blepharoplasty.
In canthopexy, the canthal ligament is simply tightened with a suture, whereas in canthoplasty, the ligament is actually cut and re-sutured.
Canthoplasty can often require drilling holes in the bone of the eyesocket through which the canthoplasty sutures are placed.
Your surgeon should be expert enough to advise you as to which procedure is most appropriate for your sitiuation.

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