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Ask Dr. Yang any questions about facial plastic surgery, including facelifts, necklifts, eyelid surgery (blepharoplasty), browlifts, otoplasty, and non-surgical treatments such as Botox and injectable fillers.
Hello. I have never had any lower eyelid surgery. However at the age of 42 I now have widening of the lateral commissure leading to slight scleral show and loss of my natural almond shape to a more rounded unattractive eye.
I am researching canthopexy as this was suggested by an oculoplastic surgeon I consulted. However another PS suggested mid facelift. I really am not keen on having a mid facelift and have no wrinkles or obvious signs of ageing apart from the change in eye shape. I have read a few horror stories on canthopexy making eyes too small or asymmetrical, and that it is difficult to undo if this is the case.
May I ask your own opinion on canthopexy, if performed by an experienced oculoplastic surgeon.
A well performed canthopexy surgery is designed to slightly tighten the lower eyelid as well as slightly repositioning the lateral canthus.
I think that canthopexy and canthoplasty procedures have their place in reconstructive procedures and in the right cases for cosmetic reasons. In your particular situation, may be the question that should be asked is "What happened to your lower eyelids over the years?" You are only 42 (very young), so I doubt you developed laxity or lost elasticity to your lower eyelid to cause this rounding which can sometimes be seen in 70-90 year old people.
Some people are born with a neutral or downward tilt to their lateral canthus. So if an older patient has a downward tilt to their lateral canthus, the only way to know for sure if this occured due to aging is to look at their pictures when they were younger. What are the chances that this very strong ligament migrated down the side of the eye socket as a person aged? I didn't realize that gravity was that strong. Since I don't know the answer to that, I don't want to make the wrong recommendation for the patient so instead I will ask for old photos for comparison. I would not "assume" that all youthful eyes have an upward tilt to their eyes, so whether or not a canthopexy is right for you depends on what you want.
Here is an example of how I analyze my patients. This is a patient of mine who has a downward lateral canthal tilt. I could have assumed that this happened due to aging, but looking at her photo at age 23, it appears that she had it even when she was younger, and this downward tilt did not make her look older. Since this had not changed we decided to leave the lower eyelids alone (if it ain't broke, don't try to fix it.) Instead we saw changes in the upper eyelids, lower face and neck, and specifically treated those areas.
Here is a second set, without makeup and with an after photo 2 months after surgery:
Now compare her at 23 and 53 after surgery. No canthopexy was performed and her negative canthal tilt is still there.
This woman did not have rounding of the lower eyelid, but she did have the downward tilt since she was young. I did not think she would look like her natural self if I tried to change the angle.
Your situation is obviously different, you have rounding of the lower eyelid (without surgery), so the question will be for you whether a slight upward tilt to tighten the lower eyelid will be a change that you are willing to live with or even like better than your current eye shape. If you don't mind the change then this is probably the right procedure for you. If you don't like the upward tilt, then you have to ask yourself if you would prefer the tightened lower eyelid with an upward tilt or just leave everything alone. This is a decision you have to make on your own.
A well performed canthopexy by a competent surgeon for the right patient with realistic goals is a good procedure. A well performed canthopexy by a competent surgeon for someone who never had an upward tilt to their eyes and wasn't really looking for that type of change, may instead lead to disappointment or even regret. This may then lead to a subsequently "quest" to search for another surgeon or technique to "undo" what was done.
I have had a couple of people who have contacted my office directly (from MMH) who have regretting this change in their eyes. One had a canthopexy and the other had a midfacelift. Looking at their before and after photos, the angle of their eyes definitely changed. To give the surgeon credit, I still thought the results were good. But when the after photos were compared to the before photos, I guess she liked how she looked in the past and didn't realize how much this small change in the angle of her eyes would change her appearance. The bottom line was she didn't want to look like a different person. This change was not acceptable for her.
Thank you so much for your very informative reply. I have noticed during more research of this procedure that articles mention there are quite a number of different methods to a canthopexy. How do we know as the patient we are getting the best one? Also are the scars hidden or visible?
Surgery is not like buying a car and a particular brand of car is essentially the same as any other car of the same, make and model. So which is the best sedan of 2009? It's really not that simple as in researching cars. Best fuel mileage, best crash test ratings, passenger room, acceleration, etc.
Surgery is more like having an artist paint you a picture. Some artists have a preference for watercolor, others acrylic, and others oil painting. If you ask a painter who normally uses watercolor paint to paint with oil paint, you will likely not get his or her best work. The same is true vice versa, unless the painter happens to be good with both styles of painting. Acrylic and oil painting has a similar consistency, so those two may be more interchangeable.
So, I ask you, which type of painting is the best one? Watercolor? Acrylic? Oils?
Since every artist who paints may have a different expertise, do you pick a type of paint that is the "best" then ask the artist to use that paint to paint your portrait, even though the type of paint and style may not be their forte?
The better way of choosing would be finding the results (or end point) that you like and let the surgeon ("artist") use their best judgement, experience, and technique that they are more consistent with to get the job done.
In general the scars are designed to be "well" hidden, but there are still scars somewhere. They may be very inconspicuous, but as long as there is an incision on the skin, the scar is not "invisible" but may be very well designed and camouflaged.
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