My Eyes are Tilted Downwards at the Ends, What are my Surgical Options? (photo)

Question

My Eye slants are tilted downwards. Besides you can see too much "white of the eye" What are my surgical options? I´m 22 years old.

Kenneth D. Steinsapir, MD · Answer

I agree that you have a low set lateral canthal angle.  This generally is associated with the shape of the facial skeleton.  Isolated lateral canthal angle surgery is unlikely to resolve the issue.  Some type of rim implant would be needed to support and increase the projection of the cheek bone.  Craniofacial surgery has proven to be a very blunt tool for this.  Unless you are having dry eye symptom, which is unlikely, operating on this can harm the important glide function of the tissues in this area.  You consider using Hyaluronic acid fillers to build this area up.  The ral challenge will be finding a surgeon who puts your best interests first.

Rian A. Maercks, MD · Answer

Your canthal angle or the angle of the palpebral fissure is indeed very low.  You are young and at least from the picture do not appear to have tarsal laxity. what this means is that a procedure called canthopexy in which the corner of your eye is elevated to just above horizontal will fix this issue while maintaining a natural appearance.  You do also appear to have an under-projecting zygoma which tends to go along with your eye findings.  Combining fat grafting to the malar (cheek) area and a canthopexy would be a terrific aesthetic improvement for you.  I hope this helps!

	 

	 

	All the best,

	 

	Rian A. Maercks M.D.

Aaron Stone, MD · Answer

It is impossible to answer your question just from looking at the photos you posted. Normally the outer corners of the eyes should be about 2mm above the inner corners of the eye. Your outer corners are obviously and well below the level of the inner corners. The surgical options can be some combination of canthopexy/canthoplasty (tightening of the outer corner ligament), bone surgery to reposition the cheek bone/zygoma or placement of implants to correct for bone deficits. You also need more close examination to make sure you do not have a mild form of a craniofacial deformity such as Treacher Collin's.

	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.

Chris Thiagarajah, MD · Answer

There are several options. Without a photo of your entire face it is difficult to judge. The lower eyelids can be raised especially in the cornes to improve the angle. However that being said I would want to look at your cheeks and see how much support you have there. This can be improved upon but without a full face photo the exact recommended procedure is tough.

My Eyes are Tilted Downwards at the Ends, What are my Surgical Options? (photo)

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