Is Lateral Canthoplasty the Best Procedure for Round Eyes and How Much Does It Cost? (photo)

Question

I am a 46 years French woman. Due to mask lift, my look has been totally changed (it's hard to explain). I used to get almond-shaped eyes. I've been desesperate for more than 6 years; I don't recognize myself in the mirror and other people's opinion is not the same.

Kenneth D. Steinsapir, MD · Answer

DB

	You are absolutely correct to say that your eyes have changed.  However, your analysis of the problem is not correct.  I suspect that very few surgeons you consult will understand the issues.  At the same time I am equally certain that many surgeons would be more than happy to perform a lateral canthoplasty for you.  They will mean well but they are simply going to make your situation worse, not better.

	I completely agree that surgery has altered the shape of the eyes.  This is the most obvious change.  The outer corners of the eyes are higher after surgery compared to your preoperative status.  There is also a subtle lower eyelid contour abnormality of the lower eyelids.  It is true that a properly executed lateral canthoplasty has the potential to reposition the lateral canthal angle.  In my many years of repairing prior eyelid surgery, I have found that very few surgeons are capable of actually achieving that type of result in a natural way.  Not impossible, just very difficult as the surgery must be done with the patient at least awake enough to open an close the eyes to judge the effect of repositioning of the angle.  If your patient is under general anesthesia, then in my opinion, the likelihood of success is very low.

	One problem with canthoplasty, and to a lessor degree cathopexy, is the risk of over shortening the lower eyelid. It is true that many surgeons will shorten the lower eyelid as part of the canthoplasty procedure.  The procedure is taught this way and this maneuver is important for pathologically lax eyelids.  However, over shortening an eyelid that does not need to be shortened will simply force the lower eyelid below the curvature of the eye.  This will actually make the lower eyelid look more pulled down.  I assure you this is not the outcome you are looking for.

	So lets go back and talk about the real issue.  It is interesting how important the eyes are in interpersonal interaction.  Subconsciously, we scan the face of the person we are speaking to.  During conversation, we actually scan a triangle on the face that includes the eyes, the nose and to a lessor degree, the mouth.  This is so profoundly ingrained, that one expects someone listening to you to look at you in this manner.  So much so, that most of us will not even be aware of this gaze pattern.  However, we can be acutely aware when the pattern is altered in someway.  What you would experience when you are speaking to someone is the sense that they are not really paying attention to you.  When does these happen?  Studies have shown that changes in the face will alter this scan pattern.  There are some very nice studies of this in the head and neck literature in looking at scan patterns when viewing someone who has a facial lesion or just had surgery to remove a facial lesion.

	How does this apply to you?  If you look carefully at your after photograph, you face demonstrates a classic facial defect caused by your mask lift.  The forehead dissection has resulted in atrophy of the fat pads that extend from the temple to the orbital rim.  This hour glass hollowing of the temple areas I call the plateau midface deformity.  Essentially the loss of the fat volume skeletonizes the zygomatic arch.  This little bit of facial fat plays a critical role.  This cushion of fat at the side of the face serves to separate the eye aesthetic area from the temple aesthetic area.  This slight cushion of volume helps maintain gaze on the eyes.  Without this fat volume, the scanning gaze is falls off the eyes and is drawn into the temple area.  You are left with the feeling that people are not paying attention to you.  Since the primary reason many women (and men) have cosmetic surgery is to stay relevant, this feeling of being ignored can precipitate a narcissistic crisis.  The fact that your surgeon can not understand your concerns (and I promise you they really don't get it) is even more infuriating.  Because like you, they don't see what the issue is, you get treated like a problematic, ungrateful, impossible to satisfy (insert your own description here) person.  Naturally this can precipitate a break down in the doctor patient relationship.

	Now what to do with this information.  First, there is no substitute for an actual personal consultation.  Generally for this type of problem the best solution for many is adding hyaluronic acid filler to the area where you have lost volume.  These products last quite a while and this can be a workable alternative to corrective surgery.  For some, surgery is necessary.  The most important thing is to avoid having a fix by doctors who do not understand what the issues are. Unfortuately, if you don't see it, you can't fix it.

	Hope that helps.

Stephen Prendiville, MD · Answer

As others have commented, the aesthetic changes that have occurred to your eyes were transformative as opposed to rejuvenative. From what I can gather, the "mask lift" is a form of subperiosteal mid face lift which is supposed to accentuate volume in your cheeks. The stigmatic side effects of this procedure include lower lid retraction, lateral canthal blunting, and overall changing of the shape of your eyes. Although the problem can be corrected, it requires expertise in facial anatomy and surgery.

Mehryar (Ray) Taban, MD, FACS · Answer

Your problem is not uncommon. Your lower lids are too low; your lower lids are too short horizontally, and the lateral canthus is rounded. These have changed the shape of your eyes and hence face, as "eyes are the windows to the sole".  An exam is needed but typically it requires reconstructive lateral canthoplasty with midface lift and lower lid graft to elevate the lower lids.  You should see an oculoplastic surgeon.

	Dr Taban

Roger P. Friedenthal, MD · Answer

I am not clear exactly what was done during your mask lift, but your eyes are rounder as compared with your photos from before the procedure. There does appear to be a detachment of the outer corner of your eye from its attachment to the bone. If you feel the area of the outer corner of your eye with the tip of your finger, you will note that the outer corner of your eye is no longer attached to the bone. They will be separated by perhaps 3-6 mm (1/8" to 1/4"). Technically this is a stretching or detachment of the lateral canthal ligament from the lateral orbital rim. You are correct that a canthal correction is the best approach. The two common variations on this are a canthopexy, in which the ligament is shortened, and a canthoplasty, in which the ligament is detached and reattached. There are also some variations on these procedures if more strength is required, but usually a canthopexy or canthoplasty is sufficient. You do need a plastic or ophthalmic plastic surgeon who is familiar with the procedure because it is not as well known as it deserves to be. The cost is usually comparable to that of a blepharoplasty. This can be handled. Good luck.

Robert T. Buchanan, MD (retired) · Answer

Without knowing more about your procedure and exactly what was done (since, as I understand it, this may involve folume modification) It is hard to tell you what options you do have. Canthoplasty, however, is probably not one of them, though repositioning the canthus may be. There are also multiple other methods to modify your eyes. See a Plastic Surgeon who has significant experience with eye modification and have your operative report from your previous procedure so that he/she can compare what is seen now with what was done then.

Is Lateral Canthoplasty the Best Procedure for Round Eyes and How Much Does It Cost? (photo)

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