Dr. Wants to Do a Canthopexy to Fix my Lower Eyelid After He Took Too Much Skin? (photo)

It has been 5 weeks since my lower eyelid surgery to remove loose skin and wrinkles, and my left eye (reversed in picture) still has an ectropion. The dr. (plastic surgeon) who did the surgery says it is an easy in office procedure that requires only a 1 stitch canthopexy to fix it. He said he could do it next week. I need to know if this will fix it, or should I have an occuplastic surgeon do the correction? The eye had an ectropion from day 1 and I cannot live like this anymore. Do I trust him

Doctor Answers 8

Canthopexy is not easy

We agree that given your experience and photos, canthopexy is the likely solution to add lift and support to the lower lid. The comment that canthopexy is an easy in office procedure with one stitch however is a misconception. Problems are harder to fix than to prevent. There is a red flag here that might have you consider a second opinion.

Chicago Plastic Surgeon
4.0 out of 5 stars 43 reviews

Dr. Wants to Do a Canthopexy to Fix my Lower Eyelid After He Took Too Much Skin?

Without examining you, it is impossible to know whether the canthopexy will be enough or if some of the removed tissue needs to be replaced to allow your lid to lift and again protect your eye. I do agree that massage will likely help with this issue but is unlikely to completely remedy it. In the meantime, make sure your eye is protected at night time and that you're using drops to prevent dryness of the eyes. If you have any concerns about the plan, seek a second opinion and an oculoplastic surgeon would be a good choice. I hope this information is helpful.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

Canthopexy is not "one stitch" and is not "easy."

You have a pretty significant ectropion, and while aggressive skin removal is one cause of this problem, there can be others. Re-operation may be necessary on a more urgent basis if you have corneal drying issues, but if your tear film and corneal lubrication is adequate, the longer you wait, the softer your scar tissue will be, and the more likely successful your canthopexy (and final appearance improvement) will be.

Pulling on tissues that are firm and edematous (scarred) is like trying to get balsa wood to stretch. Hint: it often doesn't work!

Your own surgeon may well be trying to minimize the situation with his description of the recommended "fix," but if inexperience caused the initial problem, them perhaps it may also be an issue with the proposed "easy, one-stitch" canthopexy. Seek additional opinions until you are comfortable. Ask about stretching exercises, steroid eye drops, Restasis, or skin hook traction on your lower eyelid. In some cases, a Frost suture to attach the lateral lower lid to the lateral upper lid can help stretch out the lower lid scar tissue with each eye blink. Many options exist, but doing nothing is not a good choice here. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Lower eyelid retraction after blepharoplasty

Canthopexy may or may not correct the problem.  There are two main reasons why your lower eyelid is retracted:  1) tight lower eyelid skin;  2) weak orbicularis muscle, responsible for blinking.  It takes time (up to 6 months or more) for the latter to recover, for which surgery is not recommended.  It is wise NOT to do any further surgery for at least 3 months (and hopefully 6 months) to give time for things to heal.  I recommend you see an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 73 reviews

Canthopexy Ectropion Correction

Canthopexy can be an effective solution to a mild lower eyelid ectropion after blepharoplasty surgery.Tthe key is the timing of this revisional procedure. It is better to wait until the tissues are softer and less inflamed as the result can be better. But if the symptoms warrant it (dry eye and irritation) then earlier intervention can be done. It can be done as an office procedure under local anesthesia.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Ectropion after blepharoplasty 5 weeks.

It is too soon for any surgery.  Wait at least6 months. The swelling is pushing your lower lids down. Steroid drops will help. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

The Role of Canthopexy

A Canthopexy procedure is meant to give strength back to the attachment of the lower eyelid to the outer corner of the eye.

Some things to know to guide you best down the road to recovery:

  1. A close exam of the muscle and skin of the lower eyelid BEFORE surgery can often predict who will be prone to ectropion (pulling away of the lid from the eye)
  2. Canthopexy can be done at the same time as the lower lid blepharoplasty or in some cases after if an ectropion is noted
  3. The healing process from any eyelid surgery can take several months. If ectropion is suspected early on, taping the eyelid upwards can help prevent further loosening while the underlying tissue strengthens
  4. If ectropion persists or worsens over 6 weeks, a repair procedure such as canthopexy is likely to be required. It would definitely be wise to get a second opinion from an experienced Facial Plastic Surgeon or Oculoplastic Surgeon.
  5. In the meantime, using lubricating drops and eye gels are vital to keeping the surface lining of the eye (the cornea) from drying out and getting damaged

Manu Gujrati, MD
Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

Ectropion after lower eyelid blepharoplasty

You are not completely healed at 5 weeks post op, meaning your eyelid could become more ectropic as it completely scars.  It isn't unreasonable to want to fix it now, but you should be aware that it may still change further.  Upward massage on the eyelid can help some, but is unlikely to correct this problem.  I would recommend a consultation with an oculoplastic surgeon to determine if there is scarring of the eyelid layers or just laxity.  This can change the management.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

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.