Will a canthoplasty put the margin back against my eye? (photo)

I had lower eyelid surgery with canthopexy two years ago and now my eyes are rounded, sagging, dry and irritated. Need expert opinions on whether I have lower lid retraction. Also, wondering if it is ectropion. I don't like the look of my lower eyelid margin rolling forward. Will a canthoplasty put the margin back against my eye or will it still look everted even with this procedure? I am not willing to go back to my original surgeon for advice. Any opinions and advice would be greatly appreciated.

Doctor Answers 2

Proceed carefully is my advise.

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You do not have lower eyelid ectropion as far as I can tell from these photographs.  You do have post surgical contour and lid positional changes associated with the prior surgery.  This includes a lid margin rotation from loss of skin and scaring just below the eyelashes from the lower eyelid surgery.  You may also have a disinsertion of the lateral canthal tendon but this is not well documented in the photographs you have provided.  You asked if a lateral canthoplasty will correct your issues.  The answer is that alone, canthoplasty does not have the power to correct the visible issue present in these photographs.  For this I rely on using a hard palate graft for the purpose of shaping the lower eyelid contour and facilitating a lid margin roll correction.  A physical examination is needed to determine if skin is needed in the front of the eyelid.  If that is the case, I generally will perform a vertical midface lift over a hand carved orbital rim implant.  My rationale for this is detailed in my publications.  If one were to simply perform a canthoplasty, there is a substantial risk that the lower eyelid shortening will simply pull the eyelid margin under the curvature of the globe making the eyelid position worse. 

Beverly Hills Oculoplastic Surgeon
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Will a canthoplasty put the margin back against my eye?

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        If there is an actual deficiency of tissue in the vertical dimension, then you will need something else.  If you have laxity of the lower lid, then a canthoplasty can be utilized.  An exam would be necessary to sort this out.  Find a plastic surgeon with ELITE credentials who performs hundreds of facial and eyelid surgeries each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

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