Can my canthopexy be reversed?

Question

Had canthopexy 1 yr ago now considering reversal. Sclera was showing but don’t like small eyes now. Had cheek implants to get rid of negative vector, now considering cheek-lift to support bottom lids. 1) Any way I can open up edges of my eyes but keep support in bottom lid so no sclera shows? Possible to just loosen stitch instead of remove it? 2) Is reversal still an option, or is it possible that scar tissue developed sealing eyes small? Options to open them if there is scar tissue?

Kenneth D. Steinsapir, MD · Answer

Very little that is performed surgically can be reversed.  You need reconstruction.I personally think you have volume in the wrong part of the face.  This is due to submalar volume from the implant.  I would recommend taking out the cheek implants and replace them with a hand carve ePTFE rim implant.  This will achieve a more heart shapes face.  I think your cheek volume is too low.  It is part of what makes your face look disturbing.  Stop asking for a canthoplasty.  Some well meaning surgeon will actually attempt this.  Further shortening your lower eyelid will cause the lower eyelid to ride further under the curve of the eyes.  In other words, canthal surgery will pull the eyelids down more.  In order to "reverse" the canthal surgery, the lower eyelid needs to be horizontally and vertically lengthened.  I would also consider controlling the shape of the lower eyelid with a hard palate graft.  Study my website which has a lot of information about this type of reconstructive surgery.  Try to minimize further damage to your face.  You need to carefully research you best options.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question and the preoperative picture. Where is the post op picture?Yes, canthopexy can usually be reversed but it is difficult to help you without a current picture.

To be sure what might work for you, see two or more board
certified and experienced plastic or occuloplastic surgeons in your area for a full and complete
evaluation.

I hope this helps.

Amiya Prasad, MD · Answer

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.

Can my canthopexy be reversed?

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Can my canthopexy be reversed?

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Everything you need to know about Eyelid Surgery

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