My Thoughts on Medial and Lateral Canthoplasty for Asian Blepharoplasty

Besides creating a supratarsal crease in the upper eyelid for Asian blepharoplasty, there are two other modifications of the eyelid shape that can be performed, namely a medial and/or lateral epicanthoplasty.  The canthus describes the joining of the upper and lower eyelids so the medial canthus describes the inner corner of the eye near the nose and the lateral canthus describes the outer corner of the eye near the temple.  A modification of the shape of the canthus is thereby known as a canthoplasty.  The predominant medial canthoplasty performed is intended to change the shape of the eyelid from a closed shape to a more pointed appearance; whereas the lateral canthoplasty is intended to lengthen the eye and thereby have a larger eyelid aperture.

By far the most common procedure involves the medial canthus, or medial canthoplasty.  The method that I use I learned in South Korea and involves making my incision inside the curvature of the canthus itself, i.e., not on the naked skin between the eye and the nose.  I believe that the medial canthus is prone to scarring and any incision that is created on the skin can lead to unpredictable scar formation.  That is why I prefer to perform my procedures without a skin incision in this sensitive area that has a tendency toward webbing and scarring.  The key maneuver with a medial canthoplasty is to actually shorten the medial canthal ligament to create a durable change to the medial canthal shape.  The goal is to open up the canthus to show the pink portion of the eye known as the lacrimal lake.  When the ligament is shortened, the eyelid shape looks like a cat eye for 1 to 2 weeks, which then relaxes.  The goal for a good medial canthal procedure is that it is subtle and not overly sharp, which can look artificial.  With the method mentioned above, it can be performed in conjunction with a double-eyelid procedure or separately.  In my opinion, I prefer a slight medial canthal roundness that I think preserves ethnicity.  However, I am always open to discussing with a patient whether he or she would like to have the canthal procedure performed to achieve his or her aesthetic goals.

The lateral canthoplasty is a procedure that is far easier to perform but with far more limited gains.  I personally have stopped performing this procedure because I believe that the improvements are too modest to justify the procedure.  The goal for lateral canthoplasty again is to open up the canthal width simply to have a more open eye.  The technique involves cutting the canthus approximately 3 mm open and then removing a slight degree of redundancy and tacking the upper eyelid canthal skin to the upper eyelid canthal skin and the same for the lower canthal skin.  Even though the recovery for this procedure is very negligible, I have seen the 3 mm expansion return to only a mm or 2 of change, which to me is too slight to justify this procedure.  For those individuals who are willing to accept the limited gains of this procedure, I am still open to trying it, especially since the recovery and risk are both relatively low.  The type of lateral canthoplasty that I personally do not like is the z-plasty method to lower the outer canthus downward to make the eye less “slanted” in appearance.  The reason that I do not like it is that it violates my principle of trying to avoid cutting on exposed canthal skin, that can lead to visible scarring that is very hard if not impossible to fix.  I think if these modifications are understood in the context above then they can be safely performed as adjuncts to the standard double-eyelid blepharoplasty.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. Call (972) 312-8188 to schedule a consultation or to ask Dr Lam a question about Asian blepharoplasty please visit our Asian plastic surgery forum.