Thank you for your question!
You submitted two sets of photos and you’re asking: can you change the shape of your lower
eyelid.
And it’s clear that you’ve been doing research using terms like lateral canthoplasty
and lateral tarsal strip to see if it’s possible to get or achieve the shape that
you want.
Well, I can certainly assist you with this question.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon.
A significant part of my practice is enhancing lower eyelids as well as restoring, in terms
of reconstruction, complications of cosmetic surgery affecting lower eyelid.
So I can give you some guidance as to the possibility but in the absence of a physical
exam, it is limiting my ability to give you a full answer but I can explain to you a few
things that you should understand before undergoing any procedure.
So to begin with, you have to ask yourself: what is it about this change which appears
to be approximately 1-2 millimeters of one eyelid instead of being slightly rounded or
a natural curve which is probably your natural anatomy.
You want to bring the eyelid up a couple of millimeters.
This question you have to ask yourself is will there be a significant enough improvement
that can justify this type of surgery?
From the limited photos, I would probably expect that you are younger and you have to
understand some of the other elements of what it means to operate on someone who is younger
but let’s begin first with anatomy and what are the elements of the anatomy that affect
the position of the lower eyelids.
Well, to begin with, let’s start with the bone structure.
The bone structure is the framework which the lower eyelid is attached and it’s attached
by a medial and lateral canthal tendon.
Now the framework is also affected by the relative position of the eyeball and the soft
tissue of the orbit and the soft tissue within the eye socket.
So when you think of this single procedure, what you’re describing as doing something
to pull the eyelid in a way that would try to create this level position.
I don’t that it’s likely to happen when you do those types of procedures.
Sometimes you can get some improvement but you also have to take into account the other
elements of the anatomy.
There are 3 main elements of the anatomy that’s very important to understand.
There’s the lateral canthal tendon which is the tendon that attaches lower eyelid to
the inside of the outer aspect of the eye or the orbit.
There’s the posterior lamella or the tissue behind the eyelid and there’s the anterior
lamella, the tissue in front or the skin and the muscle.
Now those 3 elements work together.
So when people come to me who have complications of cosmetic eyelid surgery, I very often have
to do surgery to address all 3 elements in order to restore proper position.
Now that being understood, you have to ask yourself and when you do a consultation with
a specialist like myself, what of those elements do you have to do in addition to try to achieve
this?
And a lot of times, you can probably not need additional skin in the front but you do need
something in the lower eyelid or in the inside.
That is typically some type of graft material.
Now when we say graft, it means that your body also has to provide it with a blood supply.
So you can hear that it’s now getting a little more complicated.
And when you have variables like this, it makes the procedure less predictable and there’s
always some room for some degree of asymmetry.
So it’s not just surgical skill because surgical skill can achieve certain look on
the table but then the body has to heal in a way that is consistent and predictable and
that being said, you have to understand that when dealing with fractions of millimeters
and with the relative specificity in what kind of outcome you want, you have to factor
those variables in before you move forward with surgery.
It’s important to understand that once you do these types of operations, they can’t
be fully undone and so it’s a big commitment to consider something like this for a limited
improvement.
So a lot of times, when people come to me with these types of situations, once I explain
this, they tend to not want to do that they think that originally, it was just a simple
type of tightening procedure but those simple tightening procedures don’t work long term.
Sometimes you can get a one or two millimeters by releasing something called the lower eyelid
retractors but in order to kind of figure that out, you have to have a physical exam.
So it’s important that you actually meet with specialists like myself, an oculofacial
plastic surgeon, particularly those who focus significantly on cosmetic surgery and it’s
a small number.
And once you have the information, you have to make a very difficult decision and whether
or not you’re willing accept the possibility of the asymmetries and the possible need for
additional surgeries.
Revision surgery is part of cosmetic surgery.
It’s never a 100% avoidable.
All specialists perform revision surgery.
It’s just part of the deal that the human body heals in a way that may or may not be
the way we want.
So with the being said, I hope that was helpful, I wish you the best of luck and thank you
for your question!