Does an Under Eye Skin Pinch Need to Be Associated with a Canthopexy to Prevent Ectropion? (photo)

I am a 24 year old female and I have lax skin under my eyes, which creases up when I smile and forms wrinkles. If I place a finger just bellow my eyelashes and pull the skin up, I notice that the skin is tightened and the wrinkles are a lot less visible. I am hoping to benefit from an under eye skin pinch, but have heard that this can cause the lower eyelid to turn outwards. Should this procedure always be associated with a canthopexy to prevent ectropion? Thankyou for your help

Doctor Answers 12

Lower eyelid skin removal and ectropion

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Mornin' Lilo.   Get a couple of consults with Oculoplastic or Facial Plastic surgeons before doing anything.  At your age lid laxity is a little unusual.  HOWEVER, in your photo your eyes are big and quite attractive but those nice big eyes and your cheek bones make for what's called a "negative vector."  Yours is probably not bad at all but I can't tell without an exam.  Because of your anatomy you are at slightly more risk for retraction or ectropion so whom ever is telling you this may be correct.  You don't always need a true canthopexy (which many plastic surgeons don't do very well in any case).  Sometimes a skin-muscle flap with a orbicularis plication may do just fine.  Talk to your Facial Plastic or Oculoplastic surgeon.  Good luck.  Don't get in a rush to surgery, you've got beautiful eyes.  Dr. Lay


Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Lower Eyelid Pinch

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Without a formal evaluation, it is hard to determine whether or not you will need a canthopexy in addition to a lower eyelid pinch.  Sometimes this can be done without a canthopexy.  Please consult with a board certified specialist who can best assist you in achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews


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The answer to your question can only be given after an "in-person" consultation. The tone of the canthal ligaments [what attaches your eyelids to the bone] will determine if you need tightening of the eyelids or not. Most younger patients do not need tightening, as long as the lower lid blepharoplasty is via a conservative pinch excision of skin as opposed to an aggressive skin-muscle flap.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Need for canthopexy

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A canthopexy is used to tighten the canthal tendon, and prevent the lid from pulling down when lower eyelid surgery is done.  It is typically used when the lower lid has loosened with age.  There are methods of examining the area at the time of your consultation to determine if you will need one.

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 9 reviews

Does an Under Eye Skin Pinch Need to Be Associated with a Canthopexy to Prevent Ectropion?

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There is NEVER an ALWAYS in plastic surgery. Some patients need only the "pinch" while others could benefir from a canthopexy. Seek in person evaluations 

Lower eyelid lines and wrinkles

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It is very unusual for a 24 year old to have much excess lower eyelid skin. Fine lower eyelid wrinkles is not equal to excess lower eyelid skin and lower blepharoplasty with removal of lower eyelid skin to remove all lower eyelid fine wrinkles is fraught with complications. You should have your vision checked and if you are a smoker quit because squinting regularly from either cause can create these wrinkles. This muscle action will not change because you removed some skin or lasered it. If either of these conditions is treated/resolved you would then be better off smoothing the skin with a peel or laser. Furthermore the skin thinness and visible tear trough will also not be addressed by a pinch removal of lower eyelid skin.

Canthopexy is performed to treat or prevent ectropion in those patients who have a lax tendon in the outer corner of the eye. In the absence of that a canthopexy may pull the lid down the lower half of the eyeball creating more problems than it solves.

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

Pinch Lower Blepharoplasty and Lateral Canthopexy

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For most lower eyelid pinch techniques, a lateral canthopexy is not needed. The main principle behind a pinch excision technique is that minimal skin (3 to 5mms) is removed. When more than that is removed, consideration should be given to a lateral lid tightening.

Lower blepharoplasty with skin pinch

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Lower blepharoplasty with skin pinch does not always need to be combined with a canthopexy, particularly in someone who is young and has good eyelid tone. Canthopexy is only required if the lid is weak or already has some preoperative laxity. 

Dr. Jamil Asaria

FACE Toronto

Jamil Asaria, MD
Toronto Facial Plastic Surgeon
4.8 out of 5 stars 139 reviews

Lower Eyelid surgery for young women in Los Angeles

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lower eyelid pinch blepharoplasty is designed to remove excess lower eyelid skin with minimal cause for ectropion. Especially in a young woman the chance of ectropion is very small after a lower eyelid tuck such as this.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 51 reviews

Canthopexy and skin tightening lower lids

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Based on the photo you submitted, you do have what is referred to as "scleral show," that is the white of your eyes can be seen underneath your colored iris. It is indeed likely that you need a canthopexy to tighten your lower lid, since if the surgeon just tightened the skin, your lid would likely pull lower. In point of fact, a canthopexy will elevate your lower lid while getting rid of the scleral show and may be all that is needed to tighten the skin. A canthopexy would, of course, change the appearance of your eyes somewhat by not showing the white sclera underneath your iris, so you do need to be all right with this.

Roger P. Friedenthal, MD
San Francisco 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.