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 cheeklift 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 followup 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.
How Lower Eyelids Can Be Raised After a Previous Surgery to Reduce Scleral Show Whites of the Eyes
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!.