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."