Failed Canthoplasty 8 Weeks Ago, No Results, Suggests Canthopexy?

I had a canthoplasty on my right eye 8 weeks ago to correct a mild ectropion after a lower blepharoplasty went wrong. During the last two weeks my eye has gone back down again and looks the same as it did before. I am going back to see the oculoplastic surgeon who performed my canthoplasty but not my blepharoplasty. He suggested I may need a canthopexy? I am very concerned about this as I do not want to go through another op that could fail or even make things worse. Please help what should do?

Doctor Answers 4

Lower eyelid retraction

If the lower eyelid is under tension (or tight), then a canthopexy or canthoplasty alone won't resolve the problem. The tension or tightness needs to be relieved also. Discuss with an oculoplastic surgeon.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 74 reviews

May need more aggressive surgery

Whether you have a canthoplasty or canthopexy [and these terms are often used interchangeably by some surgeons] they both involve tightening the eyelid, which may be counterproductive.

You may need lower eyelid retraction repair to help lengthen the eyelid vertically. This is done by grafting tissue [many different options available] to the backside of the eyelid. 

Posting photos would be helpful for us to give you a better opinion.

If you decide to explore this further, I would recommend consultation with another ASOPRS trained Oculoplastics surgeon for a second opinion. You can find one close to you on the ASOPRS dot org website.

Good luck

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 41 reviews

If a canthoplasty did not get the job done, a canthopexy won't either.

A cathopexy is a weaker version of a canthoplasty.  A canthoplasty is a deep reconstruction of the lateral canthal angle.  It is the strongest form of canthal surgery.  The problem is most likely that the "mild ectropion" you have is a more profound structural issue than you and your most recent surgeon realize.  A canthoplasty is not really capable of supporting the lower eyelid, which unfortunately is news to many canthal surgeons who rely on this as their go to tool for fixing lower eyelid malposition.  Procedures that horizontally shorten the eyelid (canthopexy and canthoplasty) can actually make lower eyelid vertical inadequacy worse.  This is because a shorter lower eyelid has to follow a shorter closed path along the surface of the eye.  this will be lower on the eye surface forcing the lower eyelid margin further below the curvature of the eye.  You did not provide a photograph of your situation.  However I would not double down on the wrong surgery.  Allow yourself to heal and consider getting additional opinions regarding the best way to improve your situation.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid retraction

A canthopexy may be beneficial to correct the lower eyelid retraction.  I would discuss with your surgeon if in addition to the canthopexy a mucosal graft would help release the lower eyelid and avoid recurrent retraction.  

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 52 reviews

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