What can be done to fix a rounded lateral canthus? (Photo)

Question

I had upper and lower bleph (transcutaneous) with canthopexy 2 1/2 years ago. The lateral canthus on both sides is rounded. Two questions: 1) Is this considered a canthal web, lateral shortening, or both? 2) what (if anything) can be done to fix this? I am more concerned about fixing the severe dry eye and lagophthalmos I suffer from each day rather than fixing it for cosmetic reasons. I also have a bit of lower lid retraction.

Kenneth D. Steinsapir, MD · Answer

Eyelid surgeons for the most part try to simply fix the eyelid, but this will not be adequate to fix your lower eyelid retraction and rounding of the lateral canthal angle.  To address these problems, I developed surgical methods to recruit more tissue from the cheek that takes the weight of the cheek off of the lower eyelid.  It is those forces that have caused the rounding of the lateral canthus.  That is a type of tissue pull back.  To definitively fix this, cheek soft tissue and skin is recruited by vertically lifting the cheek onto a custom orbital rim implant.  The implant has nominal volume and is primarily used as a felting material to support the weight of the cheek.  A hard palate graft spacer is also used to control the shape of the lower eyelid.  Short-cut methods cannot reliably control the shape of the eyelid or resist the weight of the cheek.  Please study my free ebook, cited below that describes this approach in more detail.

Carlos Mata, MD, MBA, FACS · Answer

Hi,Thank you for your question.It would be helpful to have more views of your eyes to give you a better assessment. The best recommendation would be to go and get a Consultation by either a facial plastics, oculoplastics or plastic surgeon To evaluate what is going on with your eyes. It is hard to say whether it's  lateral shortening or a web without a physical examination. There are a number of ways to correct your issue however each surgeon has their personal preferences In terms of how to fix the situation/problem. Dry eyes is a know issues after ANY eyelid surgery. Make sure that whomever you see has been able to correct issues such as yours. Good Luck. Be patient. Remember that no surgeon can guarantee you that your dry eye problem will go away but may get substantially better.All the best,Carlos Mata MD, MBA FACSBoard certified plastic surgeon

Toby Mayer, MD · Answer

Cheek lift to correct rounded lateral canthus. You have tension pulling your lower lid down and this can be corrected with a cheeklift. I use an Endotine to hold the cheek up until scarring takes over. See a very experienced surgeon who is familiar with this technique.

Mehryar (Ray) Taban, MD, FACS · Answer

The reason for rounded lateral canthus is "tension" including horizontal lower eyelid tension and vertical lower eyelid tension. Improvement is possible to release the tension through lower eyelid elevation and revision canthoplasty. See my website for more information.

Shoib Myint, DO, FAOCO · Answer

Hello blef leppard,
You have lateral canthal rounding ( some may choose it to be called webbing). The solution to your rounding is not that difficult. Sharpening that angle can be done with a small surgery. You will need to discuss this option with an Oculoplastic surgeon. The bigger picture appears to be your lagophthalmos. There are few surgical options for this problem ranging from minor to more involved techniques. That issue in my opinion should be addressed first. In the end there is hope for an acceptable outcome which should make you happy. Hope this helps. 
Cheers.

Chris Thiagarajah, MD · Answer

There are many options but the best would be a spacer graft. There are going to be people that recommend a canthoplasty but in my opinion it won't be enough.

Paul Nazemi, MD · Answer

Thank you for posting your photo and question.  There is rounding of the lateral canthal angle.  The cause of the lagophthalmos (i.e. inability of the eyelids to fully close) must first be determined with an in-person examination.  The cause would determine the best treatment option.  The lateral canthal "web" or shortening can also be treated.  Best wishes.

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