Canthoplasty/Blepharoplasty/Brow Lift - Which option is best for me? (photo)

Question

I am a 20 something year old with hereditary eye hollows, but the rest of my face is full. My natural eye shape (without eyelids) are not almond shape. They are sad and droopy, and my eyes tend to tilt down at the outer corners, which are round. I also have very heavy brows that weigh down my eyes. What can I do to a) fix the bags and restore height to cheeks, b) tilt eyes up and a create symmetrical almond shape ?

Michael Kreidstein, MD, FRCS(C) · Answer

A blepharoplasty with canthoplasty is the appropriate procedure for elevating the lateral corner of your eyelid and improving lower lid hollows.  You should see a surgeon to discuss this option.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Thank you for your pictures. Based on your examination I think that a canthoplasty would serve you well in addition to a transconjunctival blepharoplasty. This would all be determined all your physical examination therefore seek several consultations from board-certified plastic surgeons.

John J. Martin, Jr., MD · Answer

You have full brows, but they are already pretty high.  If you do a browlift, they will be overcorrected.  You have some hollowing of the lower lids.  I would recommend some hyaluronic acid filler.  This will help to improve the appearance of the lids, and decrease the dark circles.  You would need to be seen in person to give an opinion on canthoplasty.  Make an appt. with an oculoplastic surgeon who can evaluate your lower lids and canthal angle.

R. Laurence Berkowitz, MD · Answer

You are young.  Proceed with caution.  The photographs suggest deficiency of the soft tissues under the lower eyelids and also above the upper eyelids. Fat grafting done with restraint is a consideration.  Canthoplasty will change the shape of the eye and I would try volumizing the tissues before cutting and moving the canthus.

Michael Law, MD · Answer

Without more photos or an in person consultation, there is no way to know what would be ideal for you. But, I often use fat grafting to fill under eye hollows. When expertly performed, the results are natural, smooth and beautiful.

R. Stephen Mulholland, MD (retired) · Answer

Dear Twentytwo22,

Thank you for submitting your photos and clinical history as
they are very helpful.  Because you are
quite young, you are quite correct in that you have inherited a lid, brow and
ocular shape.  Lower lid tilting or
aesthetically malpositioned lids would generally require a lid repositioning
procedure called a canthoplasty.  There
will need to be stable fixation of the canthal tendon into the bone, both on
the inside and possibly outside of the eye and the outer angle of the eye.  Although difficult to tell from your
photographs, brow position would need surgical repositioning through and
endoscopic brow lift with stable fixation. 
The deep sulcus in the upper lid may be aggravated by a brow lift and
soft tissue fillers placed into this area may soften an otherwise hollow
orbital socket.

Quite clearly, this is rather extensive surgery for someone
who is young and very careful pre-operative planning, visiting with several
plastic surgeons with extensive experience in orbital-facial lid and brow
repositioning would be necessary.

All surgery comes with some degree of risk recovery.  The benefits that one achieves need to be
carefully planned out.  Sometimes optimal
shape and contour, particularly of the canthal position, cannot be obtained.

I hope this information is of some assistance and best of
luck.

Sincerely,

R. Stephen Mulholland, MD

Certified Plastic Surgeon

Yorkville, Toronto

Canthoplasty/Blepharoplasty/Brow Lift - Which option is best for me? (photo)

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