Introduction
In the vibrant and cosmopolitan city of New York, canthoplasty has emerged as a popular cosmetic and reconstructive surgical procedure. Canthoplasty, which involves modifying and reshaping the corner of the eye, offers both functional and aesthetic benefits. Whether addressing issues like lower lid laxity, ectropion, or simply enhancing the appearance of the eyes, finding the right surgeon for canthoplasty in New York City is crucial. In this article, we will take a comprehensive look at canthoplasty, including the top surgeons in the area, its procedure details, and other relevant aspects.
Canthoplasty: An Overview
What is Canthoplasty?
Canthoplasty is a surgical reconstructive procedure designed to modify and reshape the corner of the eye. The medial and lateral canthi play invaluable functional and structural roles. The medial canthus gives a medial angular contour to the eye, aids in the lacrimal pump mechanism, and prevents ectropion. The lateral canthus contributes to the overall shape and health of the eye, and its position is a subconscious indicator of youthfulness. Canthoplasty can be used to re - establish eyelid function, amend eyelid malposition, or satisfy aesthetic preferences.
Indications for Canthoplasty
There are two main types of indications for canthoplasty: functional and cosmetic.
Functional Indications
- Entropion: Both congenital and involutional forms can be addressed.
- Ectropion: Congenital, involutional, and cicatricial types may require canthoplasty.
- Lid laxity: Seen with anophthalmos, enophthalmos, or facial nerve palsy.
- Canthal dystopia: This can cause problems with eye function and appearance.
- Exposure keratopathy: Canthoplasty can help protect the cornea.
- Epiphora: Excessive tearing may be due to issues with the canthus that can be corrected.
- Vertical eyelid retraction: Such as after blepharoplasty or in thyroid eye disease (with some contraindications).
- Trauma or iatrogenic damage: Repair can restore normal eyelid function.
Cosmetic Indications
Cosmetic canthoplasty aims to alter the lateral canthal angle to achieve a more desirable appearance. There are cultural differences in the desired outcomes. Among Asian populations, it is popular to lengthen the palpebral fissure and change the angle of the lateral canthus to tilt downward, giving the eye a larger appearance. In Western patients, age - related canthoplasty often aims for an upward canthal tilt to lift the orbital and local midface structures.
Preoperative Evaluation for Canthoplasty
History Taking
A thorough history is essential. Surgeons need to know the mechanism of injury, the time since injury, and any negative sequelae. Information about comorbidities is collected to guide decisions around anesthesia. Patients should be asked about medications and conditions that cause excessive bleeding to avoid potential retrobulbar hemorrhage and blindness. For example, the use of continuous positive airway pressure (CPAP) poses a risk for postoperative edema, and hypertension should be regulated. Non - steroidal anti - inflammatory drugs (NSAIDs) should be discontinued for at least two weeks before the surgery. Since dry eye is frequently reported postoperatively, questions about previous symptoms of dry eye and potential causes are also asked.
Physical Examination
Ocular Examination
A full eye exam is conducted, including a slit lamp exam to analyze the corneal surface, assess for dryness, and check for punctal eversion or stenosis. A Schirmer test may be performed to determine if there is a component of ocular surface disease. The margin to reflex distance (MDR) is measured to assess for ptosis. A Hertel exophthalmometer may be used to measure existing proptosis. Attention is also given to any visible neoplasms, skin discoloration, or actinic damage to the area, as well as any facial asymmetry or deformities. The positions of the eyelids, canthal angle disparities, and intercanthal distances are noted, and the strength and function of ocular muscles are assessed.
Lateral Canthus Measurements
For lateral canthoplasty, the distance from the lateral canthus to the orbital rim is measured for successful lengthening of the palpebral fissure. The degree of eye slant is also measured if the goal is to achieve a specific canthal angle. A cosmetically aesthetic anatomy has a lateral canthal angle approximately 4.1 degrees or 1.2 mm higher than the medial canthal angle, which also allows for proper tear film distribution and lacrimal drainage.
Lower Eyelid Laxity Assessment
Inspection of different aspects of the facial anatomy is done to fully characterize lower lid laxity. Excess skin is identified by pinch tests. The lower eyelid's position when retracted is measured, and the causes are addressed. Preoperative and postoperative photography is suggested, capturing the eyes in five different positions. The ideal position of the lateral canthus is up to 3 mm higher than the horizontal plane of the medial canthus. Several lid laxity examinations are performed preoperatively, such as the distraction test (both medial and lateral) and the snapback test, to prevent postoperative lower lid malposition.
Surgical Techniques for Canthoplasty
Medial Canthoplasty Techniques
C - U Medial Canthoplasty
This technique is often used for patients with blepharophimosis - ptosis - epicanthus inversus syndrome (BPES). The goal is to amend epicanthus and telecanthus when used in tandem with lateral canthoplasty. The surgical approach involves inducing general anesthesia, calculating the amount of tissue to be removed for the ideal intercanthal distance, marking specific points on the patient, removing the skin and orbicularis muscle to reveal the medial canthal tendon, shortening the tendon, and closing the incisions.
Y - V Medial Canthoplasty
It is used to treat telecanthus caused by disruptions to the medial canthal tendon. General anesthesia is induced, points are marked on the patient, incisions are made, the medial orbital wall periosteum is dissected, the medial canthal tendon is separated, and oblique transnasal wiring is used to secure the tendon in the desired position.
Medial Canthoplasty Repair for Canthal Rounding
Can be applied to both the medial and lateral canthus in cases of canthal rounding due to iatrogenic injury or trauma. The anterior and posterior lamellae are separated, new lid margins are created, and they are secured with sutures. If there is lid laxity, it can be combined with a canthopexy.
Modified V - W Medial Canthoplasty
Especially useful in Asian patients with an epicanthal fold and a shallow orbi - nasal angle. Points are marked on the skin in a geometric w - shape, areas of skin and muscle are excised, and the canthal ligament is adjusted to correct the shape.
Medial Canthoplasty with Microplate
In cases where there is a portion of soft tissue or bone missing in traumatic etiologies, a microplate is used to bridge the gap and fixate the medial canthal tendon. The plate is positioned, holes are drilled, screws are inserted, and the tendon stump is secured.
Lateral Canthoplasty Techniques
Dermal Orbicular Pennant
Useful for patients who require canthal support or have had unsatisfactory results from horizontal shortening procedures. A flap is outlined laterally from the lateral canthus, the underlying dermis and orbicularis are incised, the lateral retinaculum is released, and the dermal pennant is secured with sutures.
Inferior Retinacular Lateral Canthoplasty
Popular for both reconstructive and cosmetic canthoplasty. It involves making an upper eyelid crease incision, raising a skin - muscle flap, separating the inferior portion of the lateral retinaculum, dividing the lateral canthal tendon, and attaching the inferior component to the inside of the lateral orbital rim.
Lateral Retinacular Suspension
Often performed along with an upper eyelid blepharoplasty. A transcutaneous incision is made below the lateral canthal tendon, sutures are passed through the lateral retinaculum, and they are secured to the periosteum inside the lateral orbital rim.
Lateral Tarsal Strip
Combines horizontal lid shortening and lateral support. A lateral canthotomy and inferior cantholysis are performed, the tarsus is separated, a strip of tarsus is cut, and it is attached to the periosteum inside the lateral orbital rim.
Tarsal Sandwich
Used when traditional techniques are not adequate to correct certain lower eyelid malpositions. It is a combination of the tarsal strip technique and lateral tarsorrhaphy. Incisions are made, the lid is divided into lamellae, and sutures are used to create the desired shape.
Adapted Aesthetic Lateral Canthoplasty for Asians
Specifically designed for Asian patients. Anesthetic eye drops are administered, incisions are made along the lateral canthus crease line, the lateral palpebral raphe and superficial lateral palpebral ligament are dissected, and a canthopexy is performed with sutures.
Alternative or Concurrent Treatments
Blepharoplasty
With the normal aging process, the skin of the upper and lower lids stretches, and the underlying muscles weaken. Blepharoplasty addresses this by eliminating surplus skin. For the lower lid, it is often used to treat ectropion. In transconjunctival lower eyelid blepharoplasty, markings are made, a corneal shield is placed, an incision is made through the conjunctiva and lower lid retractors, the lower eyelid orbital fat pads are debulked or repositioned, and the wound is either sutured or left to close on its own.
Tarsorrhaphy
This procedure connects the upper and lower lids to close the eye for corneal protection. There are temporary and permanent tarsorrhaphies. In temporary tarsorrhaphy, bolsters are used to close the eye, which can be opened and closed during examination. In permanent tarsorrhaphy, interrupted sutures are used to join the lateral third of the upper and lower lid while maintaining a central opening for visibility.
Lower Eyelid Sling
Used to manage combined medial and lateral canthal tendon laxity. A fascia lata graft is taken from the lateral thigh or palmaris longus tendon, and it is used to attach the tarsal plate to the nasal bones and the orbital rim.
Postoperative Care and Complications
Postoperative Care
After canthoplasty, patients are given antibiotic, steroid, and artificial tear eye drops. Oral antibiotics and ophthalmic ointment may also be prescribed. Steroid eye drops should be tapered and discontinued once palpebral conjunctival swelling subsides. Patients are advised to avoid impact to the surgery site and not rub the eye for three weeks to avoid dehiscence. They should refrain from activities that increase blood flow to the eyes, such as heavy lifting or bending. Swimming pools, saunas, and contact lenses should be avoided for three weeks, while face washing and light showers are permitted. Keeping the head in a raised position can improve bruising or swelling, and sunglasses are recommended to protect from sun and wind exposure.
Postoperative Complications
Several complications can occur after canthoplasty:
- Ectropion: Some individuals with abundant lid laxity are at risk. Proper technique selection can help reduce this risk.
- Trichiasis: Misdirected eyelashes can cause irritation and corneal morbidity. Cryoepilation may be used to manage it.
- Chemosis: Swelling of the eyelids and conjunctiva is common, usually self - limiting. Cryotherapy and cautery can increase the likelihood of this complication.
- Symblepharon: An abnormal adhesion between the bulbar and palpebral conjunctiva can develop due to trauma during surgery.
- Corneal erosion: Exposed suture material can lead to this, which presents as foreign body sensation, photophobia, and red, watery eyes. Treatment involves lubricating drops, antibiotics, bandage contact lenses, and removal of the foreign material.
- Lacrimal fistula: Damage to the lacrimal ligaments can cause prolapse of the lacrimal gland and the formation of a fistula.
- Bleeding and scarring: There is a risk of extensive and unpredictable bleeding, and scars may not heal properly due to excess scar tissue, genetic predisposition, or misplaced incision. Revision surgeries may be an option but do not guarantee resolution.
- Lacrimal drainage system injury: The medial canthal tendon's close relationship to the lacrimal drainage system makes it susceptible to injury. Conjunctivo dacryocystorhinostomy (CDCR) may be used to rebuild the drainage system.
- Misalignment: Movement of one eyelid or tendon in relation to the other can lead to canthal disparity and misalignment of the mucocutaneous junction.
Top Canthoplasty Surgeons in New York City
When it comes to canthoplasty in New York City, there are several highly - regarded surgeons. According to Healthgrades, some of the best doctors who perform canthoplasty and canthopexy in the area are as follows:
| Surgeon Name | Rating (out of 5) | Location |
|---|---|---|
| Dr. Neil Nichols, MD | 4.40 | 114 E 27th St, New York, NY 10016 |
| Dr. I Rodgers, MD | 4.30 | 229 E 79th St, New York, NY 10075 |
| Dr. Paul Langer, MD | 4.50 | 90 Bergen St, Newark, NJ 07103 |
| Dr. Ana Alzaga Fernandez, MD | 5.00 | 212 East 69th Street Suite 5, New York, NY 10021 |
| Dr. Grace Sun, MD | 4.10 | 36 Worth Street, New York, NY 10013 |
| Dr. Ashley Brissette, MD | 4.90 | 1305 York Avenue 12th floor, New York, NY 10021 |
| Dr. Benjamin Chang, MD | 4.70 | 185 Madison Ave fl 2, New York, NY 10016 |
| Dr. Stuart Carter, MD | 4.90 | 1305 York Ave fl 11, New York, NY 10021 |
| Dr. James Kelly, MD | 5.00 | 160 E 56th st fl 9, New York, NY 10022 |
| Dr. Thierry Hufnagel, MD | 4.70 | 185 Madison Ave fl 2, New York, NY 10016 |
| Dr. Kira Segal, MD | 4.90 |
