Can My Inner Eye Corners Be Widened?

Q: Dr. Eppley, I am writing to you with great respect for your extensive experience and contributions in the field of craniofacial and aesthetic surgery. I have been researching potential avenues to address a specific aesthetic concern I have, and your name consistently comes up as a leading expert regarding more niche but possible surgeries. My concern relates to the spacing of my eyes. While my interpupillary distance is within a normal range, I feel that the inner corners of my eyes (the medial canthi) are positioned relatively close together. This gives my eyes a narrower appearance in relation to the rest of my facial features than I would prefer, and I believe it detracts somewhat from overall facial harmony. I understand that altering the structural relationship between the eyes can be complex. I am not seeking a drastic change (the change seems to be a few millimeters), nor am I approaching this lightly. However, I am keen to understand if there are any established surgical techniques or approaches that could potentially help increase the intercanthal distance, even modestly, to achieve a more balanced look. I would be very grateful for your perspective on whether this type of concern is something that can realistically be addressed surgically. If procedures do exist, could you perhaps offer some general insight into what they might entail, their potential effectiveness for achieving a subtle widening of ICD, and importantly, the typical risks involved? I am trying to carefully weigh whether the potential aesthetic improvement could justify the complexities and risks associated with any relevant procedures. Like I said, moving the eyeballs is not what I’m looking for but rather narrowing the horizontal eye width by changing the medial canthi position (through whatever means you would consider to be safe and direct). I am serious about exploring viable options and am prepared for the associated costs. However, my primary aim at this stage is to first understand the general possibility and validity of such a procedure before proceeding further, for example, with a formal consultation, should a potentially suitable and reasonably safe approach exist. I am happy to provide photographs if that would help clarify my concern at any stage. Thank you very much for considering my inquiry. I appreciate your time and expertise.

A: Essentially what you are describing is the reduction/elimination of the lacrimal lake area of the inner eyes. This could be done by a v-shaped incision along the medial edges of the upper and lower eyelids, excision of the lacrimal lake mucosa and a straight line closure. This moves the inner eye corner more laterally. It is not clear to me yet what the role of any medial canthal tendon manipulations would be or if even needed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon