Dear Dr. Seckel, I have had 2 blepharoplasty surgeries (all four eyelids) and still Look tired as my lower lids hang way down and I feel for lack of better word my eyes look like a basset hound. I had the scalpel blepharoplasty with the visible scar on my lower eyelids, I did not have the transconjunctival blepharoplasty you write about and I did not have the arcus marginalis release. I also did not have the laser. First surgery was with plastic surgeon, second was with occuloplastic surgeon, went back to a third plastic surgeon and he mentioned I should have had a canthoplasty instead. Does suturing the ligament to the bone cause eventual sagging because of weight of the cheek and gravity over time? Thank you for your time, Renée, Minneapolis,
Dear Renee,
The look you describe, also called the sad eyed look, hound dog eyes, ectropion, or scleral show, is the most common problem after traditional scalpel blepharoplasty of the lower eyelid. Modern Blepharoplasty usually avoids these problems. During the traditional lower eyelid blepharoplasty when the incision is made on the outside of the lower eyelid and through the supporting muscles, the support for the lower eyelid is damaged and frequently the lower eyelid turns down and creates the “sad eyed look” or “hound dog eyes” you write about.
There are several new techniques which, when combined together, I call the “modern blepharoplasty” which avoid the sad eyed look or hound dog eyes after blepharoplasty.
First, I use the transconjunctival laser lower blepharoplasty approach. I make my lower eyelid incision on the inside of the eyelid, the pink conjunctiva instead of on the outside, thus I do not cut through the muscles and supporting structures of the lower eyelid. This avoids damage to the support of the eyelid caused by the external incision and helps prevent the sad eyed look, technically called an ectropion.
The other maneuvers I use during a modern blepharoplsty are called a canthoplasty and an orbiculopexy. Canthoplasty involves tightening the supporting ligament of the lower eyelid, the canthal ligament by suturing it to the bone of the orbit or eye socket during the blepharoplasty. This tightens the lower eyelid and restores the natural youthful shape of the lower eyelid. A smaller procedure called a canthopexy can be used in many cases.
The orbiculopexy is a procedure which tightens the eyelid muscle which overlies the cheek and actually tightens and lifts the cheek during the blepharoplasty. Both the canthoplasty and orbiculopexy are done through the upper eyelid incision of the upper blepharoplasty, which is done to remove hooding of the upper eyelid or eye hoods.
These maneuvers comprising the modern laser blepharoplasty create a youthful eyelid appearance, removing eyelid bags, loose skin, dark circles under the eyes, and eyelid hooding, while preserving the beautiful eyelid shape and avoiding the sad eyed look or hound dog eyes.
The canthoplasty, if done correctly by an experienced blepharoplasty surgeon, should correct the basset hound look you complain of. The canthoplasty should tighten the lid and should not be pulled down by the cheek. It is a strong repair and done properly is a permanent correction.
Thank you for your question.
For more information on blepharoplasty eyelid rejuvenation,and plastic surgery read Save Your Face or contact me.
Boston, Massachusetts