Correction of an Over-done Canthoplasty?

Question

After a canthoplasty, my eyes are asymmetric and much smaller. By this procedure, my upper eyelids were also pulled down at the outer corners. Is there any procedure to enlarge at least one eye to restore symmetry?

Kenneth D. Steinsapir, MD · Answer

Dear Mily
First I encourage you to look a my website: lidlift.com.  Look at the pages on fixing eyelid surgery and midface surgery.
Canthal angle surgery affects the apparent size of the eyes.  This occurs for several reasons.  First sagging of the lower eyelid either by gravity or from eyelid surgery changes exposes more of the white of the eye.  Our brains associate with with a big eye which is desirable .  When the canthal angle is tightened some of this white is covered up making the eye look smaller.  The solution to this is to fix that canthal angle at a lower point along the orbital rim so that less of the white is covered.  
Another reason the eye can look smaller is that the canthal angle normally inserts at the bony orbital rim.  When a canthoplasty or canthopexy is performed the canthal angle may not reach the bony rim.  The tissues may heal with tension on the canthal angle.  The net result is the horizontal width of the eye opening is smaller after the surgery making the eye look smaller.
Finally, with the swelling associated with eyelid surgery and sometimes just the wear and tear of daily like the upper eyelid gives.  This upper eyelid heaviness hides the eye and contributes to a smaller looking eye.
The challange you will have is finding an eye plastic surgery with sufficient interest and skill to address your issues.  It takes both a great deal of training in eye plastic surgery and an interest in this particular problem to effectively address these issues.  I am actually not area of anyone in Europe to recommend for you.  There are a handful of surgeons such as myself who focus on repairing prior eyelid surgery.  Yes these issues can be fixed.  A personal consultation with the right surgeon is necessary to determine the best approach for you.  I would recommend that you look at the ESOPRS (European Society for Ophthalmic Plastic and Reconstructive Surgery) website and look for someone who trained in the US and performes hard palate graft lower eyelid reconstructions.

William Portuese, MD · Answer

There are revisional canthoplasty surgeries that can be performed to improve the shape of the lower lids and make them more symmetrical.  Go back to your original surgeon and discuss your options with that person.

Brooke R. Seckel, MD, FACS (retired) · Answer

I would wait at least 6 months before considering a revision of a canthopexy. The tissue relaxes a great deal in the first 3 months following canthopexy.
Revising a canthopexy to open the eye can be very difficult, especially if skin was removed from the lower eyelid to tighten the eyelid skin.
This is a very sophisticated procedure, and I recommend that you consult an expert in oculoplastic surgery if you are unhappy with your original result at 3-6 months.

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