Canthoplasty

People who are dissatisfied with their external appearance often seek the practice of a plastic and aesthetic surgeon. Cosmetic surgery is supposed to help you make yourself more attractive to other people, especially the opposite sex. Canthoplastics are usually carried out in connection with eyelid lifts. The patients are women who want to give their eyes a mysterious expression. However, there are also cases where there is a medical indication.

What is canthoplasty?

A canthoplasty is a surgical procedure performed on an outpatient basis, which is desired mainly for cosmetic reasons. If there is a medical indication, it is a malformation such as a narrowing of the eyelid, diseases of the eyelid, injuries to the eye, tumors on the edge of the lid and in its immediate vicinity and an age-related, unsightly distortion of the lid axis downwards that is associated with a weakened lower eyelid.

In patients with facial paralysis, it corrects the resulting asymmetry of the eyelid angle. Bulging eyes that appear as a result of Graves' disease or myopia (nearsightedness) are made narrower. In canthoplasty, the outer corner of the eye is pulled up a few degrees and fixed in this position. Patients who want this procedure have drooping outer corners of their eyes that give their face an exhausted and sad look. The lateral lid plasty is always performed on both eyes for reasons of symmetry. During canthoplasty, canthopexy, tightening and fixing of the lid edge takes place.

The surgical intervention takes place primarily as part of a lower eyelid tightening. Very sagging lower eyelid skin is corrected by the surgeon by removing skin, muscles and often also fatty tissue from under the edge of the eyelid. This usually leads to the occurrence of an ectropion (postoperative lowering of the lower eyelid, combined with increased lacrimation and conjunctivitis). So that this does not happen, the surgeon always performs a canthopexy after the lower eyelid tightening. He can use the cut already made for the lower eyelid tightening. The pinel test (measurement of the tension of the eyelid ligament) before the operation shows whether the patient still needs canthopexy during the lower eyelid tightening.

Function, effect & goals

Canthoplasty gives the female patient a particularly expressive look ("cat eyes"). The slightly almond-shaped eyes make her more feminine and exotic. From a medical point of view, an existing or possibly occurring ectropion is corrected with canthoplasty. During the operation, the lower edge of the eyelid is incised in the outer corner of the eye to gain access to the tendon. The incision is made in the natural curvature of the eyelid so that the scar is later invisible.

Then the edge of the lid is pulled up slightly. The orbicularis oculi muscle is sewn to the periosteum of the temporal bone. If the canthoplasty is performed as part of a lower eyelid tightening, the surgeon uses the 1 cm long incision already made for you at the point where there are already natural horizontal folds. If the lower eyelid has too much excess skin, it removes a small piece of skin near the corner of the eye and brings the edges together so that the tissue is tightened even more. When performing canthoplasty, surgeons use different procedures. Which one is used later depends on the surgeon's preferences and the patient's anatomy. Before the operation, the patient is given intravenous sedation.

The operating area is anesthetized locally. Depending on the complexity of the case, the entire medical procedure takes 1 to 2 hours. The wound is covered sterile with a small gauze bandage. A few days later, the patient has a feeling of tension in the eyelid area. Slight skin irritation can also occur. To relieve the pain, he is given an analgesic that he must take every 6 to 8 hours. If the patient is healing normally, the stitches will be removed about 8 days later.

If the swelling has not decreased significantly by this time, the sutures can only be pulled later. The bruises that are often visible after the procedure are not a cause for concern. They disappeared after 4 weeks at the latest. Ice packs help to reduce the postoperative swelling even faster. The patient can see an initial change in their facial expression after 2 to 6 weeks. However, he can only assess the final result of the operation after one year, when the wound healing process has been completed.

Risks, side effects & dangers

Postoperative consequences of canthoplasty can be: dry, itchy or burning eyes, reduced vision (double vision, blurred vision), increased tear flow and increased sensitivity of the eyes to light. The strong tears in the eyes usually disappear after a few weeks.Inserting the contact lenses two weeks after the operation at the earliest can lead to an uncomfortable feeling at first.

There are only risks for the patient if the surgical procedure is carried out by a doctor who is not specialized in canthoplasty and eyelid corrections or who does not have many years of experience in this medical field (operations on the lower eyelid are generally more difficult than interventions on the upper eyelid !). Otherwise, of course, the usual consequences that surgical interventions can bring with them can occur: unexpected negative reaction to the anesthetic, unexpected asymmetries, secondary bleeding, infections, wound healing too slow, etc. In rare cases, the canthoplasty leads to the corrected corners of the eye again assume their original orientation.