Believe it or not, one of the most challenging surgeries for many cosmetic surgeons to perform is lower lid blepharoplasty. What makes it so difficult? The main hurdle involves repositioning of the eyelids on the outside corner (the “lateral canthus”) during the surgery. Placing the lids too high leads to failure of upper eyelid closure. Placing them too low or too loosely can lead to a drooping outer eyelid appearance.
It is important to study the configuration of the eye socket. Where the eyelid is sewn varies among patients; every surgery is different. The biggest problems arise when someone has “prominent” eyes, or when someone was “deep-set” eyes. The example below shows how the patient with deep-set eyes can end up with a “small eye” appearance (in the right eye) when the eyelid anchor point is inappropriately set too high. This patient also had the anchor point too far forward — the eyelid did not touch the eyelid at the outside corner.
The two month result after reconstruction using drill-hole eyelid fixation with the correct anchor point leads to significantly improved eyelid symmetry. There is no longer a “small eye” look.