What can be done to revise my canthoplasty? (Photo)

Question

I developed a hematoma in one eye within hours of a canthoplasty 7 months ago. The stitches needed to be undone to allow it to drain and it healed like that. I went back a month later to have the surgery corrected. It's been 6 months since the revision and that eye is still droopy and a bit swollen. They want me to return for a final correction in 2 months (no charge), but I'm a bit nervous. There is excess scar tissue in the area and I'm wondering if it's even fixable?

Kenneth D. Steinsapir, MD · Answer

The photos are in no way a substitute for a detailed in person assessment. You suffered a hematoma at the time of surgery on the right side but you had significant bruising on the left side. A detailed analysis of your dietary supplements and medication are needed to determine if this type of bruising can be avoided in the future. Stopping products that increase your risk of bruising at the time of surgery is critical to avoid a repetition of this hematoma with a future reconstruction. It is essential to understand that this is not a simple matter of repeating the lateral canthoplasty. Post-operative eyelid hematomas do lasting damage to eyelids. Yes, you revisional lateral canthoplasty bilaterally ( the left lateral canthus is now displaced from the orbital rim and the angle is blunted. There is now also lower eyelid retraction. Lateral cathoplasty will not control the shape of the lower eyelids. At a minimum you need a spacer graft to control the shape of the lower eyelid contour across the width of both lower eyelids. It is also likely that you need skin and soft tissue vertically lifted into the lower eyelid, which requires an small implant on the orbital rim to create a place to fix the advanced tissue. You also now have a release of the upper lateral retinaculum of both lateral canthus ligaments. This is causing the rounded shape of the upper eyelids. This needs to be addressed to restore the shape of the upper eyelids. Simply performing a canthoplasty is not going to fix all these issues even if the surgery is "free." I am attaching a video that documents how this is perform. The video is graphic. Discretion is advised. Your eyes can still be your best feature.

A.J. Amadi, MD · Answer

Your preop photo shows mild lower lid retraction. The original surgery should have included retraction repair with hard palate graft in combination with a lateral canthoplasty to achieve ideal, long lasting results. 
Your most recent photo shows slightly worse retraction, with right sided ectropion where the hematoma was drained.  It is possible that the worsening retraction on the most recent photo may be a subtle change in head position during photography, but the repair is likely the same: lower lid retraction repair with internal graft (no visible scar) with a lateral canthoplasty. You very likely will not need an implant or cheek lift unless you have had multiple prior surgeries to the lower lid.
Questions that need to be answered: Why was the canthoplasty done in the first place? Was this a congenital problem or was it due to prior blepharoplasty? Are you on blood thinners? Supplements? 
Your best bet is a well trained Oculofacial Plastic Surgeon with extensive experience in reconstructive AND cosmetic eyelid surgery. 
Virtual consultations are available, but as you know in person consultations provide a better ability to perform an exam and feel for eyelid scarring and mobility/restriction.

What can be done to revise my canthoplasty? (Photo)

Answers (2)

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