A Better Lateral Canthoplasty Revision: Preventing Adhesion with the Returning Fox Eye Lift!

For patients needing to revise a previous lateral canthoplasty due to side effects, choosing the right hospital and surgical method can be a distressing process.

Furthermore, with the rise in popularity of "cat-eye" or "fox-eye" looks, like those of celebrities Karina and Jennie, there has been a surge in demand for the Returning Fox Eye Lift. This has also led to an increase in inquiries about using this technique for lateral canthoplasty revision, which prompted me to prepare this post.

The Returning Plastic Surgery's Fox Eye Lift is a technique called Elastic Canthopexy. It is also a reconstructive method used for intractable ectropion cases where the lateral canthal anatomy has been so severely damaged that a standard canthopexy is no longer a viable option.

Side effects from a lateral canthoplasty stem from damage to the structures of the outer eye corner (the lateral canthus). This is why a simple revision surgery has a high probability of failure. Let's analyze the reasons why.

#LateralCanthoplastySideEffects #ElasticCanthopexy #Elasticum

The Cause of Lateral Canthoplasty Side Effects

Unlike epicanthoplasty (inner eye corner surgery), lateral canthoplasty is a highly destructive and anatomically complex procedure. While epicanthoplasty simply involves cutting and repositioning skin, a lateral canthoplasty requires cutting the lateral canthal tendon and accessing the orbital bone. Because it is a surgery that deconstructs normal anatomy, it should not be approached lightly, as mistakes can lead to severe side effects.

The method and the extent of the incision vary greatly between hospitals and doctors. Some surgeons, fearing side effects, may only make a small skin incision. Others may be too aggressive, causing destructive complications that jeopardize eye health.

Anatomy of the Lateral Canthus

To understand the cause of side effects, one must first understand the anatomy of the lateral canthus. The lateral canthus is where the lateral canthal tendon (also known as the tarsal strap) connects the tarsal plate (the firm cartilage of the eyelid) to the periosteum (the lining of the bone).

The Importance of Tendon Dissection in Lateral Canthoplasty

For a lateral canthoplasty to hold its position long-term, this tendon structure must be sufficiently dissected to minimize the natural "rebound force" before the corner is repositioned. If the tendon dissection is insufficient, a strong force pulling the corner back to its original position will remain after the surgery.

During this process, the suture used to anchor the corner to the periosteum can tear through the tissue—a phenomenon known as "cheese-wiring." Eventually, the corner pulls back over time. However, instead of returning to its original shape, scar tissue fills in the space, creating a blunted, "ㄷ-shaped" deformity.

*Refer to previous post for more details.

The Returning Fox Eye Lift Method for Revision

Simply put, a standard lateral canthoplasty revision is a surgery to remove scar tissue and close the corner back up. However, just like the initial surgery, this can lead to unresolved issues or aesthetically unsatisfying results.

• Functional Problem (Ectropion) Unresolved ectropion after revision can occur if there is irreversible deformation and scar contracture of the lateral canthal tendon, or if the sturdy lateral orbital periosteum—the anchor point—was damaged in the previous surgery. In such cases, a simple lateral canthopexy cannot fix the ectropion.
• Aesthetic Problem (Shortening of Horizontal Length) After a standard lateral canthoplasty revision, the horizontal length of the eye inevitably becomes shorter.

The Returning Fox Eye Lift - Elastic Canthopexy

The Returning Fox Eye Lift technique can be utilized to achieve an aesthetically successful lateral canthoplasty revision. After dissecting the deformed lateral canthal structures, we use an elastic thread to anchor the corner to the strong temporalis fascia (in the temple). This avoids the "cheese-wiring" phenomenon.

Furthermore, this method allows for adjusting the horizontal length and angle of the eye, making it possible to solve both the functional (ectropion) and aesthetic problems at the same time.

Revision Case Studies Using the Fox Eye Lift

Case 1: Congenital Ectropion Correction

This patient had undergone two lateral canthopexy procedures at other clinics for congenital ectropion, both of which failed. Due to a congenitally weak lateral canthal tendon and anatomy, a simple canthopexy was ineffective. The case was successfully resolved with an Elastic Canthopexy, anchoring the corner to the temporalis fascia.

Case 2: Complication Revision

This patient had lost elasticity in her tarsal plate and developed a drooping eye corner after a previous "lowering canthoplasty". She underwent a revision, but the condition relapsed due to scar contracture of the lateral canthal tendon. She also developed functional problems, including the inability to fully close her eyes, which led to severe dry eye syndrome. The Fox Eye Lift resolved these functional issues without shortening the horizontal length of her eyes.

---

We have now explored how the Fox Eye Lift can be used for lateral canthoplasty revision. I hope this has been helpful for those who need to undergo revision surgery due to the side effects of a previous procedure.

Thank you. This has been Dr. Kim Yong-woo of Returning Plastic Surgery.