Q: Dr. Eppley, I have a few questions regarding eye reshaping procedures that I don’t think are talked about. I have always liked wide set, narrow, uptilted, “long” eyes that had an excessive horizontal span with minimal vertical height.
I have attached a photo highlighting some things.
1. Can the space between the eyes(interpupillary distance) be increased for cosmetic reasons?
2. Is there anyway to obliterate an epicanthal fold completely? Not just push it over slightly but actually turn an asian epicanthal fold to a completely caucasian eye with no epicanthal fold.
3. What surgery would raise the lower eyelid closer towards the medial? When I squint my lower eyelid, it brings up the medial lower eyelid. When I see photos of canthoplasties, it seems they elevate the corners of the eyes to create a severe cat-like look that is in the direction of vertical.
4. Relating to the top middle photo of my eyes, you can see a before and after of where I am putting a lateral horizontal vector on my eyes. Can this surgically be done with long lasting results? Again, with canthoplasties, they are done all the time as well as brow lifts but these are always either in a vertical pull or 45 degree angle pull. I’m simply looking for a horizontal pull to create an elongated look.
5. In the photos of the two women, they both have narrow, elongated, medial palpebral fissures but more importantly, the outside of their eyes are very long. There is a lot of white show to the lateral part of their irises, is there anyway to extend and create this for someone that does not have a lot of lateral eye exposure?
6. In the gentleman on the right, he also has a very elongated medial palpebral fissure, even more exagerrated than the two women. can this also be replicated on your average person?
Thank you for your time.
A: In answer to your eye reshaping questions:
1) THE INTERPUPILLARY DISTANCE CAN NOT BE SURGICALLY CHANGED. THAT IS A FUNCTION OF THE MEDIAL ORBITAL WALL BONES AND THE ATTACHMENTS OF THE MEDIAL CANTHAL TENDONS.
2) MEDIAL EPICANTHOPLASTY PARTIALLY OBLITERATES THE FOLD. IF THE L FLAP TECHNIQUE IS DONE TO THE MAXIMUM YOU CAN PROBABLY ELIMINATE IT COMPLETELY BUT AT THE PRICE OF POTENTIALLY ADVERSE AND VISIBLE SCARRING.
3) THERE IS NO SUCH SURGICAL PROCEDURE THAT CAN ACCOMPLISH THAT TYPE OF LOWER EYELID MOVEMENT.
4) THAT IS NOT A CANTHOPLASTY PROCEDURE BUT A CANTHOPEXY PROCEDURE. THAT CAN PULL THE CORNER OF THE OUTER EYE OUTWARD IN A COMPLETELY HORIZONTAL DIRECTION. THE QUESTION IS HOW DOES IT HOLD UP OVER TIME.
5) THE PROBLEM IS IF YOU PULL THE OUTER CORNER OF THE EYE OUTWARD IT WILL LIKELY CREATE A SEPARATION OF THE LATERAL LID MARGIN FROM THE EYEBALL, CREATING A SETUP FOR EXCESSIVE TEARING AND/OR DRY EYES.
6) NO THE MEDIAL PAPLPEBRAL FISSURE CAN NOT BE ELONGATED.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in eye reshaping surgery. I am 26 years old and interested to have slanted/exotic/cat eyes. I’m not sure if canthoplasty alone will achieve my goals.
I don’t know if canthoplasty alone or canthoplasty combined with a cheek lift would work better. Will the canthoplasty and/or cheek lift fail in the short run due to gravity? such as lasting no more than a few months?
A: Changing one’s eyes to a look that is more ‘exotic’ almost always means the lateral canthus (corner of the eye) needs to be elevated and be substantially higher than the inner corner. (hence the out to inner ward downward slant. Certainly the basis of doing requires a canthoplasty procedure of which the most secure would be what is known as a drill hole lateral canthoplasty which can really pull up and maintain a new lateral canthal position. This would be far more effective and secure than a canthopexy or even a standard lateral canthoplasty procedure where the tendons is sewn onto itself or to the periosteum of the inner orbital wall. Whether that would be enough depends on the tightness of your lower eyelid and the cheek skin which can really only be determined by a physical examination. The concept of a cheek lift is a supportive one to the corner of eye and/or providing more of an upward and outer sweep to the cheek and outer eye area. At your young age it would seem a cheek lift would most likely be excessive.
Dr. Barry Eppley