Can my canthopexy be reversed?
I had canthopexy 1 yr ago and now considering reversal.
Sclera was showing but don't like small eyes now.
I had cheek implants to get rid of negative vector and now considering cheek-lift to support
bottom lids. 1) Any way I can open up edges of my eyes but keep support in the bottom
lid so no sclera shows?
Is it possible to just loosen stitch instead of removing it?
2) Is reversal still an option, or is it possible that scar tissue developed sealing eyes small?
What are the options to open them if there is scar tissue?
Thank you for your question!
The photo you submitted and the having had a history of canthopexy about a year ago,
you asked several follow-up questions mostly about the scleral show and what are your options
at this point.
Well, it isn't easy for anyone to make a full recommendation with the presence of just one
photo but looking at this photo, I can share with you some of the approaches that I have
when looking at someone like yourself who comes to my practice concerned about scleral
show.
If the goal of canthopexy was to elevate the lower eyelids and to elevate the corners and
to create a shape that you like, then the lower eyelid position as it appears in your
photo is several millimeters below the iris or the limbus.
This is the area where typically, although there is a lot of genetic variation, the lower
eyelid meets the iris.
And so, getting that vertical height to the lower eyelid can be a challenge depending
on several factors.
One approach is to provide support laterally and try to elevate and maybe a get a few millimeter
or two without doing anything else.
But the other factors include the prominence of the eyes as well as the available skin
to vertically move in to the position you desire.
There are many people who genetically have prominent eyes who have their lower eyelid
relatively low and that is basically a family trait.
There are also people who have thyroid eye disease whose eyes are very prominent and
then there are people who have had, for example, a lot of people who come to use who have had
surgery in the past where their lower eyelids are retracted down.
In our practice, we look at the position of the lower eyelid at basically three factors:
One is the lateral support which is the outer corner of the eyelid where you had your canthopexy
performed.
The other aspects have to do with the front of the eyelid which we call the anterior lamella
and the other is the posterior lamella.
So there are three parts that are very important.
And the posterior lamella probably has the most significant impact in terms of the physical
vertical support.
I refer to them as pillars that keep the eyelids in a particular position.
That being said, you have to figure out for yourself what the definition of a successful
result would be.
For every one to two millimeter that you want to elevate to reduce the scleral show, it
can involve procedures such as posterior lamellar graft.
In our practice, we use a material called enduragen as well as repositioning the outer
corner of the eye or seeing if the laxity of the outer corner of the eyelid may require
some tightening.
Even when you do a canthopexy or canthoplasty procedure, the eyelid can stretch a little
bit.
You can get a little elastic regression and you may need an enhancement there.
And last, is a factor with the anterior lamella.
For someone who is relatively young, that's a very significant challenge.
And that's basically looking at a relative amount of skin that has to be recruited to
this area.
The skin can be recruited via a skin graft which is often not desirable especially in
a younger person who has not surgery in this area in the past or through an approach such
as in a mid facelift.
It's been my experience and most mid facelifts do not recruit as much as long term as they
do short term.
We have seen many patients who have had mid facelifts where the surgeon tried to elevate
the cheek and it may have been successful in the beginning but eventually, a lot of
these mid facelifts tend to descend and that causes further descent of the lower eyelid.
In the absence of a physical examination, it is very hard to make those recommendations
but I think the purpose of my response to your question was to help you and inform you
as to the anatomy that is involved in getting that vertical height.
Very often, plastic surgeons think of the lower eyelid from one perspective which is
the outer corner and we have had patients who have been over corrected where their corners
and eyelids were way too high in attempt to reach that goal of elevating the lower eyelid.
You should at least understand that there are three components: the lateral component,
there's the anterior or the front part of the eyelid and the posterior which is the
pillar or the support of the eyelid.
It is very important that you communicate with the original surgeon about your concerns
and it is also important that you also communicate what your desires and see if this is something
that your surgeon is able to accomplish.
If for any reason you feel that your surgeon is not comfortable or if your surgeon doesn't
want to do anything else, then a second opinions are always recommend to get at least educated
and to not necessarily to undermine the original surgeon but at least to get the information
that you need to make an informed decision.
So I wish you the best of luck, I hope that was helpful and thank you for your question!