If the goal of canthopexy was to elevate the lower eyelids and the corners and also to create a shape that you like, then your lower eyelid position is several millimeters below the iris or the limbus. Although there is a lot of genetic variation, this is the area where the lower eyelid meets the iris. Getting that vertical height to the lower eyelid can be a challenge depending on several factors. One approach is to provide support laterally and try to elevate to get a few millimeters or two without doing anything else. Other factors include the prominence of the eyes as well as the available skin to vertically move it to the position you desire. There are many people who genetically have prominent eyes who have their lower eyelids relatively low and that is basically a family trait. There are also people who have thyroid eye disease whose eyes are very prominent. Lastly, there are people who have had surgery in the past which cause their lower eyelids to be retracted downward. In our practice, we look at the position of the lower eyelid at three factors: the lateral support which is the outer corner of the eyelid where you had your canthopexy performed, the front of the eyelid which is called the anterior lamella, and the posterior lamella. These three parts are very important. The posterior lamella probably has the most significant impact in terms of the physical vertical support. I refer to them as pillars that keep the eyelids in a particular position. That said, you have to figure out for yourself what your definition of a successful result would be. For every one to two millimeters that you want to elevate to reduce the scleral show, it can involve procedures such as a posterior lamellar graft. In our practice, we use a material called Enduragen and do repositioning of the outer corner of the eye. We also see if the laxity of the outer corner of the eyelid may require some tightening. Even when you do a canthopexy or canthoplasty procedure, the eyelid can stretch a little bit. You can get a little elastic regression and you may need an enhancement there. For someone who is relatively young, the anterior lamella is a very significant challenge. A relative amount of skin can be recruited to this area. The skin can be recruited via a skin graft which is often not desirable especially in a younger person who has not had surgery in this area in the past or through an approach such as a mid-facelift. It’s been my experience that most mid-facelifts do not recruit as much skin in the long-term as they do short-term. We have seen many patients who have had mid-facelifts where the surgeon tried to elevate the cheek and it may have been successful in the beginning but eventually, it descends and causes further descent of the lower eyelid. In the absence of a physical examination, it is very hard to make those recommendations but I think it is important for you to understand the anatomy that is involved in getting that vertical height and those were the three components I mentioned. Some plastic surgeons think of the lower eyelid from one perspective which is the outer corner. Unfortunately, this resulted in some patients having outer corners and eyelids which were way too high in attempt to reach that goal of elevating the lower eyelid. It is very important that you communicate with the original surgeon about your concerns and your desires and see if this is something that your surgeon is able to accomplish. If for any reason you feel that your surgeon is not comfortable or if your surgeon doesn’t want to do anything else, then a second opinion is always recommend. I hope that was helpful, I wish you the best of luck, and thank you for your question.