Where should I get outer canthoplasty? How to identify facilities that prevent relapse and deformity

The basic principle for choosing where to have outer canthoplasty (lateral canthoplasty) is to select a facility that explains the limits of expansion and the possibility of relapse through measurements and photographs. Outer canthoplasty is a surgery that detaches and reattaches the tendon on the outside of the eyelid (lateral canthus ligament)[1], and if performed incorrectly, cases have been reported where outer canthus deformity and lower eyelid laxity remain, requiring revision surgery[2]. This is why it becomes a deciding factor whether the surgeon is one who designs the procedure with consideration for the support of the lower eyelid after surgery.

How much does outer canthoplasty expand the eye opening?

There are limits to the amount of expansion, and you should choose a facility that shows you these limits in advance. A study reporting a new outer canthoplasty technique that performs horizontal and vertical expansion simultaneously measured through photographs the distance from the center of the pupil to the outer canthus and the distance from the center of the pupil to the edge of the lower eyelid margin, and evaluated the changes at 6 months[3].

It is important to adopt an approach of measuring and evaluating. Verify whether the surgeon can illustrate during examination "how much widening occurs" and can explain how to create the shape of the lateral canthus (whether it becomes rounded or pointed). In East Asia, lateral canthus extension is included in textbooks as a surgical technique for eyelid surgery.[4].

How much regression occurs?

Regression is not zero, and the frequency varies by surgical technique. In a report of 400 patients who underwent simultaneous upper and lower eyelid surgery combined with refixation of the lateral canthus tendon (lateral canthus fixation), regression occurred in 17 patients (4%), temporary hematoma in 12 patients (3%), epiphora (excessive tearing) in 11 patients (3%), asymmetry of lateral canthus position in 8 patients (2%), and conjunctivitis or conjunctival edema in 5 patients (1%).[5].

This report involved a combined procedure with Sagging (skin laxity) surgery of the eyelids, not for the purpose of enlarging the eyes in younger people.[5]Even with canthoplasty for cosmetic purposes, relapse can occur, so check whether the facility discusses from the outset "what to do if relapse happens."

Why does deformity occur? Examples requiring correction

Most deformities occur when tendon management and lower-eyelid support are insufficient. In a report correcting deformity remaining in 15 patients (25 eyelids) after canthoplasty for cosmetic purposes, problems included skin tightness at the outer canthus (web), rounding of the outer canthus, margin defects of the eyelid, and areas without epithelialization.[2].

Correction uses a method to re-fixate the lateral tarsal plate (the core tissue of the eyelid)—the lateral tarsal strip technique—and restores the shape of the outer canthus and stability of the lower eyelid at a mean follow-up of 13.34 months.[2]The study subjects were women with a mean age of 32.6 years, and all had undergone canthoplasty simultaneously with other cosmetic surgery.[2].

In other words, the core of facility selection is not "cutting technique" but "design to support the lower eyelid." Medical textbooks document that complications from eyelid surgery include lower-eyelid ectropion (the margin turning outward) and difficulty closing the eye, which are corrected through secondary surgery[6], and the question is whether the physician knows how to handle these complications.

Should inner canthus incision or vertical expansion be combined?

The combination is determined by whether the eye lacks more width or height. Surgical techniques to simultaneously broaden both horizontal and vertical dimensions were reported because two surgeries were previously necessary[3]. According to Japanese clinical practice guidelines, surgery on the inner canthus side, when performed simultaneously with eyelid surgery, sometimes yields good results[7].

However, the inner canthus side is an area where scars are easily visible, and scar-reduction cutting techniques have been a focus of comparative research[8]. If simultaneous surgery is recommended, ask the physician to explain separately the purpose of each procedure, the scar location, and measures to prevent recurrence.

Checklist for identifying facilities and confirming during consultation

There are 5 things I want to confirm. Whether the width of expansion and its limits are shown by measurement[3], how the lateral canthus tendon is fixed[1], how the support of the lower eyelid is maintained[2], what to do if regression or deformation occurs[5], and why lateral canthoplasty or vertical expansion is recommended[3][7].

Whether lateral canthoplasty is suitable depends on the excess eyelid skin, lower-eyelid laxity, the shape of the lateral canthus, and the tension of the lower eyelid—it cannot be decided from an article alone. At your consultation, please have photos taken with your eyes open and closed, observe how the lower eyelid returns when pulled, confirm your desired lateral canthus shape, and have the surgeon organize which technique will produce what changes.