Occulofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

Question

Sept.2010 a temple lift was done with too strong lateral pull: the lashline moved too high in the eye, certainly the lateral part. Surgeon then attempted July 2011 to release temple skin + subperiosteal release canthus. My eyes lost horizontal length without further improvement. I'm left with slanted catlike 'horizontally shortened' eyes, lashline high in the eye particularly laterally. I get a lot of comments daily from strangers;what technical possibilities are there still to improve?Thankyou!

Kenneth D. Steinsapir, MD · Answer

Unfortunately this deformity is epidemic.  Plastic surgeons sit through fancy lectures involving trans-temple mid face lifts that include various forms of mid face degloving.  They go home and try these procedures without the benefit of understanding all of the nuances.  You are describing a complex destabilization of the lateral canthal angles as a result of your Sept 2010 surgeries.  Although you have described important details, these situations are often more complex than realized.  

	Breaking down the lateral canthal tendon at the time of surgery can permit the canthal angle to elevate.  Some surgeons think that this is actually a desirable surgical goal.  This is very rarely the case.  The outer canthal angle can be lower, higher or at the same height as the inner canthal angle, and all of these positions can be normal.  Disinserting the angle and pulling the tissue temporally can distort this angle in disturbing ways.  Also destabilization of the canthal structures of leads to shortening of the horizontal palpebral fissure, which is known as phimosis.  This causes the eye to look smaller than it did before surgery.

	Often lost in the analysis is the breakdown of fat along the orbital rim as a result of these aggressive temple lifts.  Fat located in the plane of the surgical dissection becomes damaged and atrophies.  The zygomatic arch can become skeletonized.  I have coin the term "plateau midface syndrome" to describe this effect.  Essentially the loss of soft tissue at the lateral orbital rim and above the zygomatic arch and then extending into the temple causes a profoundly disfiguring effects.  What is going on is that the subtle soft-tissue that was present before surgery serves a very important role.  This soft tissue isolates the aesthetic zone of the eye from the aesthetic zone of the temple.  This is of vital importance when interacting with people in conversation.  In conversation our gaze tracks in a triangular pattern with most of the time spend on the eyes and the mouth and lesser amounts of time on the nose.  

	Facial disfigurement alters this gaze pattern.  The gaze of the person speaking or looking at you spends less time on the eyes and more time exploring the disfigurement.  The loss of orbital rim volume associated with the Plateau Midface Syndrome causes the gaze to track off the eyes and into the temple region.  It makes the person with the Syndrome feeling like people are ignoring them.  This syndrome is very poorly understood by the surgeons who are performing these disfiguring procedures so they are dismissive of the complaint.  The issue can be addressed with fillers but when the canthal angle is also damaged, often surgery is performed to address the constellation of issues.  You can go to my website to learn more about these issues (lidlift dot com).

A.J. Amadi, MD · Answer

There are many different positions to the canthal angle, but in most patients, it is slightly [a mm] higher than the inside corner of the eye [medial canthus]. When this relationship is disrupted, most patients end up being unhappy with their appearance, because they no longer "look like myself".

	Revision with canthopexy and canthoplasty is possible, but is unpredictable in its success, as scarring can alter the late postoperative result even when we achieve success "on the table".

	A consultation with an oculoplastic surgeon or experienced craniofacial surgeon would be helpful.

Mehryar (Ray) Taban, MD, FACS · Answer

That is a unfortunate result. Reconstructive revisional surgery may be possible. It is difficult to say without any photos or examination. See an oculoplastic surgeon.

	Dr Taban

Rian A. Maercks, MD · Answer

Your concern is very prevalent these days.  recently I have seen an increase in the number of patients coming to my office for secondary correction with identical complaints.  Although it is impossible to offer a diagnosis without pictures and preferably an in person consultation, I can nearly guarantee that you have a disrupted lateral canthus.  the side of the eyelids attach to eachother (upper and lower lids) and to the inside of the bony orbit ( the eye socket).  It is commonly necessary to disrupted this aged structure in rejuvenating procedures but it is essential that it is secured back to its bony insertion.  In todays time where all types of practitioners from family medicine, dematology, ophthomology, ear nose throat etc are trying to present themselves as plastic surgeons, more and more of these mistakes are occuring. 

	 

	The good news is there is a relatively simple solution. .  . put the lateral canthus back where it belongs.   Technically what you need is a complete cantholytic canthoplasty( total separation and dissection of the lateral canthus from the cicatrix and novel placement in an anatomically and aesthetically sound position.  At your tertiary revisional stage I would trust this work only to a plastic surgeon with extensive craniofacial expertise and a good reputation.  This maneuver is very simple for someone who routinely creates normal anatomic structure on the malformed and deformed, but is quite a challenge for a practitioner with minimal training.

	 

	I hope this helps!

	 

	All the best,

	 

	Rian A. Maercks M.D.

Sam Goldberger, MD · Answer

As others have suggested, it is possible to have revisional surgery.  You should see an experienced Oculoplastic surgeon for a personal consultation.

Occulofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

Answers (9)

Answer: Shortened palpebral fissures( small narrowed eyes after surgery)

Answer: Shortened palpebral fissures( small narrowed eyes after surgery)

Answer: Oculofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

Answer: Oculofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

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Occulofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

Answers (9)

Answer: Shortened palpebral fissures( small narrowed eyes after surgery)

Answer: Shortened palpebral fissures( small narrowed eyes after surgery)

Answer: Oculofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

Answer: Oculofacial Surgeons: Revision Eye Shape Following Too Strong Lateral Pull Temple Lift: Possible?

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Everything you need to know about Eyelid Surgery

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