A woman had a lateral canthoplasty, a procedure that is popular in Asian countries like South Korea. However, the outer corner of her left eye became droopy and elongated. She wants to know if the procedure can be reversed.
Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that elongating the outer canthus or the outer corners of the eyes is very popular in Asia to create a longer-looking eyelid. In this woman’s situation, she has some rounding of the lower eyelid. Although the pink part of the conjunctiva is not seen, the eyelid looks low and the white of the eye can be seen. This position is often called as lower eyelid retraction and there may be some loss of integrity of the tendon.
With a physical exam, Dr. Prasad tries to determine the basis for the lower eyelid position. In many situations, it’s a combination of anatomic factors, like the lateral canthal tendon that's responsible for the position and the suspension of the lower eyelid. He suspects it’s been affected since there’s a rounding of the outer corner. In addition, the vertical support of the lower eyelid may need to be reinforced. Although she didn’t have a typical complication of lower eyelid blepharoplasty where there’s a loss of tissue resulting in contraction and pulling downward, she may still have relative weakness in this area. She may need some type of vertical support. In Dr. Prasad’s practice, he uses materials such as Enduragen which is the backbone of the skin that has been treated in a way so that it can be used as a graft. Acellular dermis may also be used for the purpose of raising vertical support as part of her strategy.
In the absence of a physical exam, Dr. Prasad can’ tell exactly what she would need. She should meet with cosmetic surgeons with extensive experience in lower eyelid revision surgery. Most plastic surgeons like general plastic residency don’t have expertise in this type of surgery as opposed to specialists such as an oculoplastic surgeon or a board certified cosmetic surgeon who has specific specialty-based experience with the eyelids. When she meets with these kinds of doctors, she’ll understand whether or not she’ll need vertical support in addition to some type of anchoring procedure to get the lower eyelid to proper position.
Dr. Prasad says she can reverse or enhance her results but it won’t likely be a straightforward simple procedure. She has to decide how important the result is to her and if the healing time and investment are worthwhile to achieve her objective.
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6 сен 2024
