If Canthoplasty Looks Unnatural, Why Do It?

    A properly executed canthoplasty performed when indicated improves the appearance and corrects lid laxity.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.

Kenneth Hughes, MD Los Angeles, CA

It would be nice to see pictures of your issue.

In almost all cases with your description, we do not perform a canthopexy or canthoplasty alone since cheek advancement (ie. a cheek lift) is integral to a successful result.

Of these two procedures, canthoplasty is more powerful but involves greater alteration of the canthus.

Cheeklifts are wonderful procedures in the right patient, but they cannot correct severe drooping of the lids completely.  This last factor is the most important in deciding whether to proceed with surgery or not.  

If patients' expectations are realistic, and the cheeklift with canthal adjustment will help the patient, we will proceed with corrective surgery.  

If the patients expect the moon, but have a very significant lower eyelid deformity (especially if patients have had multiple corrective attempts elsewhere), and surgery will not bring the expected result, we do not to perform the surgery.

One of the risks of lower eyelid surgery (blepharoplasty) is a malpositioning of the lower lid. Mild lower lid rounding causes increased view of the sclera (white of the eye between the colored portion, or iris, and the eyelid). Most surgeons assess the strength of the lower eyelid before performing a blepharoplasty and if they feel laxity of the lower lid, sutures are placed to tighten the lower lid and prevent a pulling down or rounding with healing.

Sometimes, despite our precautions, a pulling down occurs and you can get mild scleral show , or severe contracture called ectropion. When these conditions occur, canthoplasty surgery may be necessary to restore the natural lid position. If performed by a skilled and experienced surgeon, it should not look "fake."

When surgical scarring causes the lower eyelids to pull down and the eye shape to appear more round, we often recommend tightening and repositioning of the outer corners of the eye (lateral canthus) to fix it.  The purpose is to return the canthus to its normal position and in turn elevate the lower eyelid.  Sometimes additional procedures, such as lower eyelid cartilage or hard palate grafts, or even skin grafts, are necessary.  You'd need an exam by an experienced eyelid surgeon to know the best option.  When patients with a "normal" lateral canthus ask about a canthoplasty to change the shape of the eye, most surgeons agree that altering the position or shape of the canthus to achieve a new look can be unpredictable and unnatural in appearance.  That being said, in the right patient, it is an option.

The key to the answer lies in the fact that a normal person does not have scleral show, so tightening it can look unnatura l. In your case, you have scleral show so the lid is looser than it needs to be. Generally speaking I would do a canthoplasty in your situation. Now if the scleral show does not bother you, and you have no dry eye or tearing, then you can wait. If it is early out of surgery, I would wait. Another option could be a mid facelift to give more support on the outside to pull the lid up. Louis Potyondy