I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape? (photo)

Question

Hey 1 year ago i had surgery on my left eye.i had ptosis and canthoplasty. My corner of my eye dropped and didnt stitch togther so i had a revision canthoplasty done again.the same problem happend again..my corner of my eye is opened. My right upper eid lid is droppy What surgery can i perfrom to improve my shape of my eyes

Mehryar (Ray) Taban, MD, FACS · Answer

The likely reason the canthoplasty has failed and will fail again is because there is vertical tension on the lower eyelid that will pull the lower eyelid and canthus down over time.  The vertical tension needs to be released, either through midface lift or skin graft. See my website under "eyelid retraction surgery" and "almond eye surgery" pages.

Kenneth D. Steinsapir, MD · Answer

Your issue is that you have a weak lateral orbital rim.  Without appropriate support, the tissue wants to heal down to this area which displaced the tissue from the lateral canthus.  Simply focusing on trying to apply more tension to the lateral canthal area will not fix this issue, it will just use up more of the normal lower eyelid.  Do this too many times and there will no longer enough resources to definitively repair this issue.  I approach these types of issues using an orbital rim implant that is fabricated for you at the time of surgery.  You also need tissue from the roof of the mouth to help build up the lower eyelid so no skin graft is needed.  The skin grafts are disfiguring.  The cheek can be vertically lifted onto the orbital rim which serves a felting material to support the lift tissue.  This brings more skin and soft tissue upper ward so the lower eyelid is pushed up without tension.  The shape and contour of the lower eyelid is also helped with a hard palate graft from behind the lower eyelid.  I would caution you regarding fixed notions of where the lateral canthal angle should be.  It is true that in the classic almond shaped eye, the lateral canthal angle is neutral or higher than the medial canthal angle.  The challenge here is that determining what will be best for you.  This needs to be discussed at the time of consultation.  Lifting the lower eyelid this high will make the eye look much smaller.  So a through discussion of this issue is needed ahead of surgery to determine what you want.  It is also necessary to look at what resources you have to determine if that type of positioning is possible.  The issue with a wire canthoplasty is that they are seldom aesthetically acceptable. Finally, very few surgeons offer this type of work.  Study my free ebook for more information regarding this type of work.

Brian M. Derby, MD, FACS · Answer

Thanks for your question. This is a challenging situation for you and your treating surgeon. You have a combination of negative canthal tilt and lower lid malposition. Ongoing attempts of canthoplasty without more advanced techniques of lateral canthal fixation such as a drillhole canthoplasty and  lateral canthal soft tissue reinforcement (i.e. periosteal flap or Enduragen) will not likely be successful. Lower kid support with a spacer graft and/or mid cheek lift are also likely necessary. An exam during your consultation would clarify. Please utilize a Plastic Surgeon who is well-trained in these techniques.

Thomas Trevisani, MD · Answer

This is an interesting situation. You have slightly excessive scleral show bilaterally, and it's not clear why. If this tension can be released and improved, allowing th slower lateral lid to move upward, then the canthoplasty will be more successful.

Soheila Rostami, MD, FAAO, FAACS · Answer

The lateral canthus has to be higher than the medial canthus to be more cosmetically appeasing. the surgery to fix this finding is not an easy surgery and may not make you very happy but you need to have the lateral canthus elevated with lateral canthoplasty.

I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape? (photo)

Answers (5)

Answer: I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape?

Answer: I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape?

Answer: You have lower lateral canthus compare to medical canthus in both eyes.

Answer: You have lower lateral canthus compare to medical canthus in both eyes.

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Everything you need to know about Canthoplasty

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I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape? (photo)

Answers (5)

Answer: I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape?

Answer: I had canthoplasty done my eye left eye twice. My corner of my eye is opened. What can I do to fix my eye shape?

Answer: You have lower lateral canthus compare to medical canthus in both eyes.

Answer: You have lower lateral canthus compare to medical canthus in both eyes.

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Recommended reading

Everything you need to know about Canthoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.