After canthopexies with bone fixation in an inferior position I developed a space next to the eyeball (the canthi became detached from the eyeball), an additional skin pinch blepheroplasty made the lower lid retract. Six months ago I underwent canthopexy surgery to resolve, without any improvement: eyes look the same and are still as irritated, dry, itchy. The canthi seem positioned much more inferior than they originally were before any of the canthopexies: could this be the culprit?What to do?
Answer: The answer is simple: lateral canthoplasty is not powerful enough to repair this. The lower blepharoplasty damages the motor nerves to the muscle along the edge of the lower eyelid margin that holds the eyelid against the eye. Surgeons attempt to replace this hammock function that is damaged by tightening the lower eyelid. There are several problems with this approach. First weakness of the muscle along the edge of the lower eyelid is not the only problem here. There is also powerful scar caused by lower eyelid surgery that is also pulling down on the eyelid. The lid is tethered to the cheek by this scar. This couples the lower eyelid margin to the weight of the cheek. The lateral canthoplasty is not powerful enough to repair all these issues. The gap is there because your surgeon is not placing the tendon far enough and deep enough to the orbital rim. Even if they managed to accomplish this, it would not correct all of the anatomic problems you have. I have pioneered a definitive approach to these issues by lifting the cheek soft tissue off the top of the cheek bone and placing a hand carved rim implant made of ePTFE (Gore tex). The implant improved the situation by better supporting vertically lifted cheek soft tissue. This recruits skin into the lower eyelid without a skin graft. This also uncouples the weight of the cheek from the lower eyelid. A hard palate graft is sewn into the back of the lower eyelid to control the shape of the lower eyelid. Then the lower eyelid is then resuspended to the orbital rim. All of this work is performed through a small incision at the lateral canthus and behind the eyelid. I have helped almost 1000 people with this surgery. There are more details on my website and in my free ebook on eyelid surgery cited below.
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Answer: The answer is simple: lateral canthoplasty is not powerful enough to repair this. The lower blepharoplasty damages the motor nerves to the muscle along the edge of the lower eyelid margin that holds the eyelid against the eye. Surgeons attempt to replace this hammock function that is damaged by tightening the lower eyelid. There are several problems with this approach. First weakness of the muscle along the edge of the lower eyelid is not the only problem here. There is also powerful scar caused by lower eyelid surgery that is also pulling down on the eyelid. The lid is tethered to the cheek by this scar. This couples the lower eyelid margin to the weight of the cheek. The lateral canthoplasty is not powerful enough to repair all these issues. The gap is there because your surgeon is not placing the tendon far enough and deep enough to the orbital rim. Even if they managed to accomplish this, it would not correct all of the anatomic problems you have. I have pioneered a definitive approach to these issues by lifting the cheek soft tissue off the top of the cheek bone and placing a hand carved rim implant made of ePTFE (Gore tex). The implant improved the situation by better supporting vertically lifted cheek soft tissue. This recruits skin into the lower eyelid without a skin graft. This also uncouples the weight of the cheek from the lower eyelid. A hard palate graft is sewn into the back of the lower eyelid to control the shape of the lower eyelid. Then the lower eyelid is then resuspended to the orbital rim. All of this work is performed through a small incision at the lateral canthus and behind the eyelid. I have helped almost 1000 people with this surgery. There are more details on my website and in my free ebook on eyelid surgery cited below.
Helpful 3 people found this helpful
November 7, 2016
Answer: Retracted lower eyelid/ectropion After a previous blepharoplasty, retraction and separation of the lid from the eyeball itself can result from any combination of the following factors:
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November 7, 2016
Answer: Retracted lower eyelid/ectropion After a previous blepharoplasty, retraction and separation of the lid from the eyeball itself can result from any combination of the following factors:
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November 3, 2016
Answer: Revision canthoplasty You need in person evaluation for this likely complex problem. There is likely forces pulling the canthus away from the bone that need to be addressed. See following link. See an experienced oculoplastic surgeon.
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November 3, 2016
Answer: Revision canthoplasty You need in person evaluation for this likely complex problem. There is likely forces pulling the canthus away from the bone that need to be addressed. See following link. See an experienced oculoplastic surgeon.
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Answer: Full canthoplasty and skin graft You may need canthoplasty and canthopexy plus anterior lamella (skin) augmentation with a skin graft if things haven't improved after the canthopexy. You darn sure can't take any more skin. Look into full reconstruction with a skin graft. In LA area Guy Massry MD is excellent.
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Answer: Full canthoplasty and skin graft You may need canthoplasty and canthopexy plus anterior lamella (skin) augmentation with a skin graft if things haven't improved after the canthopexy. You darn sure can't take any more skin. Look into full reconstruction with a skin graft. In LA area Guy Massry MD is excellent.
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November 7, 2016
Answer: Lateral Retraction From the photographs, you have notable lateral retraction and inferior displacement of the lateral lower eyelid. It is unclear what the etiology is from the photograph - unlikely to be due to lateral laxity and more likely related to scarring, but you would need a thorough assessment of the lateral canthal angle and lower eyelid to determine the best course of action. I would suggest seeing an oculoplastic specialist if you have not already.
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November 7, 2016
Answer: Lateral Retraction From the photographs, you have notable lateral retraction and inferior displacement of the lateral lower eyelid. It is unclear what the etiology is from the photograph - unlikely to be due to lateral laxity and more likely related to scarring, but you would need a thorough assessment of the lateral canthal angle and lower eyelid to determine the best course of action. I would suggest seeing an oculoplastic specialist if you have not already.
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