Do I Need Infraorbital Implants To Correct A Negative Canthal Tilt?

Q: Dr. Eppley, I have attached some pictures below. I would like to inquire about lateral canthoplasty, fat transfer to the upper and lower eyelids, mild ptosis repair and spacer grafts all in one if possible. Does the doctor perform drill hole canthoplasty? I would prefer this technique combined with the spacer grafts to eliminate any chance of the lateral canthus from relapsing over time. Whatever he thinks is best for my anatomy is what I prefer, of course. I’m trying to transform my negative canthal tilt into positive by around 5-6 degrees. I understand what matters most is the harmony of the face and making everything look natural. So I’d like to hear if he thinks it’s possible while not making me look uncanny. I also understand that many times surgeons require the patient to have infra orbital implants done as a support so the lower eyelids don’t droop overtime, although I’ve seen that spacer grafts can offer the same assistance in the concept of making sure it doesn’t relapse. That’s my main concern. I’m also trying to lengthen palpebral fissure length horizontally if possible, as I’ve seen many doctors shortening the eye in order to raise the canthal tilt which is what I’m trying to avoid. I’m also aiming at keeping palpebral fissure height to a minimum. Input would be great, thanks!

A:Thank you for your inquiry and sending your pictures. All of the mentioned Orbital procedures that you have described can be performed at one time and are often done so given the effect at the patient desires to create. To answer your specific questions:

1) The need for infraorbital orbital implants in such a surgery depends on whether actual under eye hollows exist and/or the patient wants to correct them. While you do have lower midface/maxillary concavity your infraorbital and cheekbones seem to be strong. Therefore I do not believe that they are an absolute must in your case.

2) When it comes to a lateral canthoplasty the only effective procedure in my hands that has ever worked and is sustained is a drill hole technique. Therefore that is always how I do it.

3) you have to recognize that correcting a negative canthak tilt and creating increased lateral I with/length are contrarian effects. Elevating the outer corner of the eye will not necessarily make it shorter but I wouldmdoubt that it is going to make it longer.

Dr. Barry Eppley

World-Renowned Plastic Surgeon