Avoiding Bad Eyelid Surgery: Preserve the Canthus At All Costs

I oftentimes hear a patient come to me to say, “I don’t want to look like celebrity…” who has had too much surgery done or a friend that has been subject to similar bad work.  If the surgery has to do with the eyes, there is almost always some component of distortion of the outer eye canthus (where the upper and lower eyelids meet) that causes the observed problem.  I truly believe that canthal distortion accounts for the majority of unnatural identity changes that occur following eyelid cosmetic surgery.

This blog article will discuss what causes canthal distortion and how to prevent it.  The cause of canthal distortion is simply put lower eyelid surgery that tucks or manipulates the outer canthus.  This onerous result arises from cutting the lower-eyelid skin, which causes a loss of tone and strength to the lower eyelid that must be reconstituted.  Subsequently, the canthus must be suspended to the lining of the bone so that the lower eyelid then does not sag.  Unfortunately, swelling during the surgery and variable scarring after the procedure can cause the canthus to drift either too far in, too far out, too far up, or too far down; any direction of which can cause an unnatural distortion and result.  Just take a finger to the outer canthus (again where the upper and lower eyelids meet on the side closer to the ear not the nose) and pull up, down, in, or out and look at the way that it completely changes the way that you appear.

Corrective fat transfer to correct bad previous eyelid surgery that distorted the can thus and bad cheek implants (removed) that distorted the cheek areas.

How do I avoid this complication?  Simply put, I never cut on the lower eyelid skin except in major trauma cases, which fortunately I do not do anymore.  I prefer to use fat grafting to manage the aging lower eyelid with or without non-incision based eyebag fat removal, Botox, and/or skin laser treatments.  However, despite all of these treatments methods I entirely avoid cutting the lower eyelid skin and thereby almost entirely eliminate risk of cutting on the outer canthus and the related problems that can ensue.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s eyelid cosmetic surgery, and fat grafting procedures please call 972.312.8105 to schedule a consultation. If you would like to ask Dr Lam a question about facial plastic surgery please visit our Plastic Surgery Forum.