You have a combination of motor nerve injury of the lower eyelid due to the skin incision used to perform your lower eyelid surgery and a dense scar adhesion that has formed between the elements of the lateral lower eyelid and the orbital rim. Standard lateral canthal reconstruction uses sutures to support. This is called a lateral canthoplasty. A less extensive procedure that supports the outer corner is called a canthopexy. Neither the canthopexy or the more robust canthoplasty are strong enough to over come the scar tissue in your lower eyelid. Desperate to improve eyelids like yours, well meaning surgeons have attempted to use strong materials to hold the corner of the eyelid. For that reason, some surgeons have resorted to drill a hole in the orbital rim and attempt to fix the lateral canthal tissues with heavy suture or even stainless steel suture. Unfortunately, this type of work is an aesthetic failure even if functionally the position of the pulled down eyelid can be improved. The real answer is to recognize that projection of the orbital rim, associated midface ptosis together with the scar and motor weakness of the orbicularis oculi muscle of the lower eyelid all contribute to the problem. Performing a stronger lateral canthoplasty is not the answer. Instead the state of the art in repairing these defects is combination surgery with the placement of an orbital rim implant, vertical lifting of the cheek soft tissues, and placement of a hard palate graft permits a very natural reconstruction of this issue.
