Scar Reduction and Canthoplasty, SOOF Lift and Fillers, or Tarsal Strips?

After travelling for consultations with three oculoplastic surgeons in Seattle to correct undereye laxity & hollowness, I need advice as to which of the 3 recommended procedures would be best:  Scar reduction and canthoplasty, SOOF lift and fillers, or tarsal strips?

Any other advice in making the best decision on procedure and physicians would be appreciated. I am female in mid-50s and want a natural result with minimal change in eye shape.

Update: Photo added March 10, 2010:

Doctor Answers 9

Lower eyelid rejuvenation procedures

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Several of the options do indeed leave artifact, or evidence of surgery, particularly a canthoplasty or tarsal strip. These procedures are generally used for reconstructive reasons, lax lower eyelid, ectropion, etc.

We of course cannot begin to advise you without seeing pictures, taking a history of any prior surgeries, etc.

Also, you should choose the surgeon, not the technique, a theme you will see repeated daily on RealSelf.

Generally for first time rejuvenation requiring slight tightening of lower eyelid skin, we prefer an ultrashort incision cheeklift rather than a conventional lower eyelid subciliary blepharoplasty, which tends to round the eyes or cause the corners to pull down.

There are several of our publications referenced below if you are interested.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

The best procedures for the lower eyelid.

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The best procedure for you is difficult to determine without an examination. In some patients, I perform nearly all of the procedures discussed at one setting with the exception of tarsal strips or canthopexy which have the greatest potential for creating the "cat eye" look. However, sometimes these are required in cases of lower eyelid laxity to prevent lid retraction or scleral show.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Lower Lid Laxity Correction Options

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I fully agree with my colleagues. Without seeing a good quality photograph with your eyes looking forward in neutral gaze it is impossible to answer such a sophisticated question. The fact that three surgeons felt differently after fully examined you, should signal to you that there is no uniform agreement on how your situation SHOULD be handled.

The degree of lower lid looseness would determine just how much tightening the lower lid would need - canthoPEXY, canthoPLASTY or Tarsal Strip. The hollowness of the Tear Trough could be handled generally speaking with a vertical mid face lift (several such operations or a SOOF lift) or just by applying filler deep along the lower edge of the eye socket to fill the concavity.

Remember - Big operations should give Big results but at the cost of potentially Big complications. You may be happier with a "smaller" improvement which exposes you to smaller risks.

ADDENDUM 3/11/2010

The pictures you added yesterday disclose loss of attachment of the muscle lifting the upper lids (levator) resulting in the sleepy appearance. Depending on the mechanism of loss of insetion and muscle function, this may be fixed in several different ways.

The lower lids in the bootom picture APPEAR lax with SCLERAL SHOW (the position of the lower lid suggests poor tone). This would need to be fixed before any significant lower lid surgery is done especially if already associated with either tearing or dry eyes. the choice of WHICH lower lid tightening procedure (-Pexy, -Plasty or tarsal strip wound depend on the extent of looseness).

A SOOF or a verical Mid Facelift would probably correct the tear trough deformity but these are not small operations.

For a minimal potential impact on your eye shape, pick the simplest procedure. You may not derive the greatest benefit but you will not take on extreme complications either.


Peter A. Aldea, MD
Memphis Plastic Surgeon

Physical examintion and better picture can help

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You have negative vector and this means that your check bone sets back compare to the eye globe. The surgical option are vary and all depends on the surgeons experience.

My recommendation would envolve tear trouph implants the help support the lower lid. You already have tarsal show and removing ny lower lid skin without the support will make this worse.

Pleae check these pictures.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Best option for management of lax lower eyelids

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Hi there-

Without performing an exam, reviewing your goals with you and discussion pros and cons of the options, I'm not sure I could advise you.

There are often several reasonable approaches to the same problem in plastic surgery and the best one for you will depend on your goals and desired experience.

My best recommendation is that you worry less about the technique and more about who is going to do it on you... In other words, if you choose your surgeon as well as you possibly can, the procedural details will be irrelevant- you are very likely to achieve a pleasing and natural outcome because you chose a good surgeon.

Alternatively, if you choose poorly, even if your surgeon performs an operation associated with the benefits you desire, you are less likely to achieve your goals for outcome and experience.

It's the carpenter, not his tools....

Want help finding the best surgeon for you? Please read this:

Injectable Fillers work well to improve your hollow under-eye appearance.

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Well-performed, lower eyelid Injectable Fillers can dramatically improve your hollow appearance with no downtime. You should consult a board-certified physician experienced with filling this delicate area, and you should see many photos before you proceed. This will not, however, address the laxity of your lower eyelid which may require surgery.

I hope this is helpful for you.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Eyelid surgery should be a natural restoration

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Without photographs and more history it is difficult on how to advise you. If you have scar tissue, presumably you have had prior lower eyelid surgery and have an unsatisfactory result. If you have not had prior eyelid surgery, the surgeries being proposed are overly aggressive.

I encourage you to study my website (see the link below). I do a great deal of corrective eyelid surgery. The entire goal is as natrual restoration as possible. Sometimes this entails highly involved staged surgery. Other times remarkable improvement can be had by careful treatment with long term fillers injections. Feel free to email me your photos.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower eyelid options

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Without seeing your photos, I can't say for sure but all of the procedures you listed have the potential to change the shape of your lower lids and may make you look "different" not just better.  A lot depends on the laxity of the lower lids, the more lax, the more risk you take with surgery and the more you need to tighten them to minimize the risk. 

Difficult to recommend best option without more information

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Thanks for the question BUT without photos and orbital measurements HOW can any of us experts venture to GUESS the correct operation for you. Each one you mention has its merits and down falls. Awaiting photos.  

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.