Q: Dr. Eppley, I would like to improve the appearance of my eyes. My upper eyelids (just below my brow) have excess skin that hangs down, often pushing against my eyelashes. Also, I would like the canthopexy in order to make my eyes look more feminine. My eyes are very round, showing a significant amount of my sclera, and are angled down slightly at the outer corners.
A: The description of upper lid skin pushing on the eyelashes certainly indicates that an upper blepharoplasty would be needed to recreate an upper lid sulcus again. That is very straightforward and a standard periorbital rejuvenation procedure. Changing the position of the lateral canthus at the corners of the eyes can be done at the same time as the upper blepharoplasty. This is better known as a lateral canthoplasty as opposed to a canthopexy. In a canthopexy procedure the existing tendon is tightened by maintains its current position on the inner aspect of the lateral orbital wall. As a result, it tightens the lid margins but will not change their vertical orientation. Thus a lateral canthopexy will not correct a downward eye slant. A lateral canthoplasty, which relocates the insertion of the lateral canthal tendon up into a higher position on the bone is what you actually need to achieve your eyelid reshaping goals. That is done through the tail end of the upper blepharoplasty incision.
Dr. Barry Eppley