Is a Canthopexy Sufficient For My Case? (photo)

20 yrs., and looking sick and tired without an expensive amount of makeup around/on my eyes. My eyes are small in relation to my face, and have what I have been told is an anti-mongoloid slant, and thick lids. I am wondering: what procedure(s) are best for this? I have been told a Canthopexy, but I fear that a canthopexy alone, with my thick lids, would result in manly, narrow, tinier-looking eyes. Thanks!

Doctor Answers 7

You should see a board certified occuloplastic surgeon who specializes in ptosis repair and canthoplasty.

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I would recommend that you see a board certified occuloplastic surgeon who can correct the sagging of the outer corners of your eyes and the drooping of you upper eyelids over the top part of your pupils.   Ask to see lots of photos of other patients in whom he/she has corrected with these same concerns.. 

Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Canthopexy Needed?

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Based on your pictures, there are a few things going on. Your lids are droopy (ptosis), you have a lower lateral canthus, and it looks like the outer edge of the lower eyelid is pulling away (ectropion). A canthoPLASTY may be a better option. A ptosis repair would also help give a more refreshed result.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Canthopexy for the eyes

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Hi Thea_

It's a little tough without better photos but I have to say; nice instincts.  I agree with you that the canthopexy alone might allow for a bit of a heavy upper lid and  brow.  So, that being said, a canthopexy plus a concervative upper blepharoplasty and/or brow lift may be in order.  I agree with some of the other doctors who feel that canthopexy is a knee-jerk reaction to your lateral canthal position.  So a couple of things:

1.   First you need to have someone assess your entire face and the two of you see what needs to be done.   Look at the forest, not just those two trees.  

2.    Also, stick with someone who is almost exclusively a facial plastics/oculoplastics surgeon.  

3.  Have the surgeon assess the bone stock/volume/shape, etc of your orbital rim (eye socket).  Ask them if repositioning the canthus and any other needed surgeries will masculinize your face.  If they look a little surprised and thoughtful, get another opinion. 

4.  Finally, ask your surgeons if they feel augmenting your lower eyelid rim will help or be needed.  Sometimes this is required to help support and/or augment a canthopexy.

I can't tell you for sure what's what since I can't see your whole face but best of luck to  you.  

Take care

Chase Lay MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

There is no so-called ideal position for the canthal angle.

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Doctors are funny creatures.  We read or hear something once and it becomes dogma.  It is taught that the outer canthal angel should be 1-1.5 mm higher than the inner canthal angle.  However, this rule is not accurate.  The outer canthal angle can be this high, neutral with the inner angle or lower than the inner canthal angle.  The most significant factor here is relative symmetry and yes, personal preference.  Making a big change in the position of the canthal angle can be very disturbing to someone's sense of personal aesthetics.  Yes you have a so-called antimogloid slant.  A canthoplasty would help this.  However, over correcting this would be a mistake in my opinion.  I am also struck by how much upper eyelid ptosis you have and this maybe an even more important issue to correct.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Canthal procedure to correct downward sloping corner of the eye

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The lateral corner of your eye is tilting in a downward direction.   Ideally the outer or lateral canthus should be 2 mm higher than the medial canthus.  You are correct that this is termed an anti-mongolian slant.  There are many surgical procedures that may be used to help correct the problem.  This is one structural eyelid abnormality that can be difficult to fully correct.  In general, it will require a re-positioning of the corner of your eye.  This can be done with a cantholysis, which is a division of the corner of the eye and a re-positioning of the corner of eye, known as a canthoplasty.  It is also possible that the you have some degree of hypoplasia of the cheek bone or lack of soft tissue of the cheek which needs correction as well.   Photos of your whole face would be useful.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Canthopexy vs. Canthoplasty

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Thank you for the question and photos. It would be great to see how your lids relate to the rest of your face which is how plastic surgeons make decisions rather than just focussing on one part. Antimongoloid slant is exactly what you have. It is not ectropion. Repositioning of the lateral canthus is necessary such as what is done when performing a lateral canthoplasty as opposed to a canthopexy which will only lift 1 to 2 mm.

Canthopexy - canthoplasty

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Both the upper and lower eyelids attach to the bone around the eye via ligaments at the inner and outer corners of the eye. Your outer attachment point is obviously lower than normal so the upper eyelid is pulled down over the eye a bit and the lower eyelid is pulled down the surface of the eyeball. Because the left eye's attachment point is even lower than the right these changes in eyelid position are more severe on the left. There may be other contributing factors involved but those would have to be ascertained at a face to face physical examination and accounted for when planning surgery. You can push the outer corners of the eyes upward with the wooden end of a Q-tip to simulate the effect of a canthopexy/plasty. If that corrects the position of both upper and lower eyelids then a canthoplasty should suffice. I do not think a canthopexy (suture tightening of the lower eyelid ligament) alone will suffice and when you do the Q-tip maneuver I doubt you will see complete correction of the eyelid position..

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

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.