If large eyes are your secret weapon of beauty, then soft, alluring eye corners will undoubtedly elevate your charm to new heights. However, eyelid surgery isn't as straightforward as many imagine. Before going under the knife, you need to carefully consider several factors: Am I a suitable candidate for eyelid surgery? What results can I expect from the procedure?Are there any potential complications after the procedure? ... To address these and other questions, we've invited Professor Zhang Haiming, an expert in ocular plastic surgery, to share his insights on canthoplasty.
Q1. Many women with small eyes seek canthoplasty to enlarge their eyes. For which types of patients is this procedure most suitable? Why is it often performed alongside double eyelid surgery?
Professor Zhang: I believe canthoplasty primarily benefits two groups: those with pathological small palpebral fissures;The other group consists of individuals with physiological epicanthal folds seeking cosmetic enhancement. The former group has very short palpebral fissures, typically around 2cm in length. This limitation restricts eye opening, and correction is generally performed between ages 2-4. For the latter group, approximately two-thirds of the Chinese population has epicanthal folds.which obscures the inner portion of the eyeball. This creates a wider-set appearance, mimicking pseudo-strabismus. Furthermore, the tight connection between the skin at the inner corner and the upper/lower eyelids restricts upward eye movement, potentially causing trichiasis (ingrown eyelashes). In such cases, individuals seeking cosmetic improvement may undergo epicanthoplasty. Post-surgery, palpebral fissure length typically increases by 1-3mm.
Double eyelid surgery is often performed concurrently with epicanthoplasty because epicanthal folds result from webbing-like deformities of the skin and muscles at the inner canthus. The shape of the double eyelid is closely related to the severity of the epicanthal fold.Many individuals with epicanthal folds have monolids, and even those with double eyelids may develop small inner double folds due to the folds. Therefore, these two procedures are often combined.Additionally, performing double eyelid surgery without canthoplasty can lead to rapid loss of the double eyelid effect. For instance, if only suture-based double eyelid surgery is performed on a patient with severe epicanthal folds, the results may only last 1-2 months. Even with incisional double eyelid surgery alone, the effect typically lasts only about six months to a year.Does epicanthoplasty recurrence occur? Are there methods to prevent recurrence?
Professor Zhang: For epicanthoplasty, over 30 techniques have been developed internationally. During my graduate research, I experimented with various methods—such as the Y-V technique and L-shaped approach—to minimize postoperative scarring. A Korean surgeon’s design particularly caught my attention due to its favorable long-term outcomes.Building upon this foundation, I developed a novel technique: designing a triangular skin flap within the inner upper eyelid. This approach allows the opened canthus to seamlessly integrate with the outer extension of the double eyelid crease, resulting in a more natural curvature and relatively concealed scarring.
Whether epicanthoplasty results recur post-surgery also depends on the surgeon's understanding of the procedure. This understanding directly impacts their approach to flap design and muscle management. Inadequate handling increases the risk of recurrence, underscoring the importance for patients to select an experienced surgeon.
Q3. Patients are highly concerned about the risks of canthoplasty and potential complications, such as redness, hypertrophic scarring, hardening, or visible scarring at the surgical site. Could you elaborate on these issues?
Professor Zhang: In reality, the occurrence of all these symptoms is closely tied to the surgeon's attention to detail during the procedure.Regarding postoperative scarring, it must be acknowledged that as a surgical procedure, achieving completely scar-free results is unrealistic. However, with meticulous suturing techniques, significant scarring is generally avoided. At minimum, the scarring can be minimized to the point of being imperceptible from a reasonable distance. Moreover, the scar tissue typically appears grayish-white, making it less noticeable on fairer skin tones.Regarding wind-induced tearing, this may result from excessive shortening of the medial canthal ligament during surgery or disruption of the lacrimal duct. The former causes incomplete closure of the inner corner of the eye, leaving a small gap that remains open when the eye is closed. Wind then irritates this area, triggering tears. Disruption of the lacrimal duct prevents tears from draining properly, causing them to overflow.Beyond these factors, postoperative outcomes also depend on individual constitution. With proper post-operative care, no irreversible complications should persist after a period of time.
Q4. What is the typical recovery process from the end of the canthoplasty procedure to full healing?
Professor Zhang: This process is generally similar for everyone: On the first day, there is usually some bleeding, and blood crusts may form on the gauze. By the second day, bleeding typically stops. During the hospital dressing change, removing the gauze and gently cleaning the blood crusts with saline solution can help promote wound healing. Generally, the second and third days are when swelling is most severe and the appearance may be less than ideal. After the third day, swelling gradually subsides.Sutures are typically removed around days 7-8, by which point the wound has healed over 90%. However, skin may experience temporary swelling again after suture removal due to wound stimulation. The week following suture removal is when the best postoperative results are visible. After the third week, the wound may experience a rebound phase, potentially showing scar hyperplasia, hardening, or redness. Recovery after the fourth week largely depends on individual constitution.Those with good constitution may recover in 2-3 months, while slower recovery may take around half a year.
Q5. From an aesthetic perspective, the "three-part face and five-eye" ratio represents the golden proportion for facial harmony. Beyond making eyes larger and more expressive, how does epicanthoplasty improve overall facial structure?
Professor Zhang: Altering one feature can transform the entire appearance. Eyelid surgery makes the eyes appear more vibrant and confident, potentially enhancing facial proportions and overall facial structure. This outcome is also influenced by the patient's mindset, so we recommend adjusting expectations about cosmetic surgery before the procedure.
Q6. Can a failed epicanthoplasty be corrected? How is the correction performed, and what results can be expected afterward?
Professor Zhang: Generally, revision is possible as long as the initial surgery wasn't overly aggressive. For instance, if noticeable scarring occurs, the scar tissue can be removed, often yielding favorable results. However, if the procedure was excessive—such as excessive ligament shortening or skin removal—failure becomes irreversible. In such cases, revision surgery is not recommended, and I typically decline to perform it.Therefore, the possibility of revision depends entirely on the specific circumstances.