How Is A Lengthening Lacrimoplasty Performed?

Q: Dr. Eppley, I am a big fan of your work. I was wondering if you would perform a medial lacrimalplasty, z-plasty, whatever you would like to coin the term since this surgery probably hasn’t been performed for superficial aesthetic reasons. Ideally I would like to extend the medial canthi vertically downwards, I know it can affect the lubrication of the eye, tear troughs, it carries the lacrimal fluid, and it is one of the most insane eye surgeries hypothetically speaking besides orbital box osteotomy. Are you capable of extending the palpebral fissure length of the eye medially? My optometrist measured my palpebral fissure length, and interpupillary distance and said I have 66.5 mm IPD, and 34mm PFL which is way above average, but ideally I would like 2.5mm+ of PFL.

A: Based on your pictures and description you are inquiring about a Y-V advancement of the lacrimal lake region of the inner eye. This has nothing to do with the inner canthi which, unliket he lateral canthi, can not very easily be moved short of more extensive exposure. (e.g., orbital box osteotomies) This would create some increased palpebral length since the skin-mucosal junction is moved more medially. A Z-plasty is used when the angle of the inner eye is needed to be lower…a shape that you already have.

Dr. Barry Eppley

World Renowned Plastic Surgeon