The lost lambs gather as Chuddha instructs them on canthal support

[imontheloose]

Moved to BOTB. Great thread OP.

Thanks a lot, bud. Pat.

 

[Aryan Incel]

Congrats on botb @imontheloose

 

[smartstyle]

You're on an incel forum

You're on an incel forum, you need cosmetic surgery; lots of it. Many of you will be needing canthal support in particular. Fret not, Chuddha's eternal guidance is precisely what you've been longing for. Sit down and absorb, young one. Coming to the monastery on time was step one on your journey and the necessary spark in the engine.

Oh dear Chuddha, what is it exactly that we are trying to support?

View attachment 4212714
Figure 1: frontal eye anatomy​

May you now consult Figure 1, students. What we want to do to your subhuman eyes is elevate and tighten the lateral lower lid, reduce (or, ideally, erase entirely) the inferior scleral show, refine the canthal tilt, and importantly, stabilise the lid post-midface/IO work. Sounds like a lot, but you've got a hell of a lot worse you need doing, so you best strap up, son. There is a universal cosmetic standard we are after, but there are varying methods to it depending on the deformities you have. Chuddha will assist you on progressing from "what you see" → "what to do".

Understood, mighty soul, but when should we pick each tool? I'm deformed and giga-retarded.

I know you are, son. Fear not, Chuddha shall provide you a format of which each issue will be addressed: core problem(s) → primary tool → typical add-ons.

• mild lateral laxity / prophylaxis for midface or IO implants → lateral canthopexy → (+) orbicularis hitch if dynamic laxity.
• moderate lateral laxity (lower lid is too long/loose laterally) or lateral rounding / early ectropion → tarsal-strip canthoplasty → (+) drill-hole fixation if periosteum is weak.
• vertical lower-lid retraction (inferior scleral show) → spacer graft (usually from thin HPM/auricular) + canthoplasty → (+) SOOF/midface suspension if lid-cheek distance is long or midface descent contributing, not exclusively because of a -ve vector per se. If -ve vector, follow the below pathway instead.
• -ve vector undergoing rim/IO augmentation → canthopexy or canthoplasty + SOOF/midface suspension + orbicularis hitch.
• medial laxity/telecanthus (very rare cosmetically, but some of your deformities genuinely surprise me, so I will not rule anything out) → medial canthopexy.

Oh knowledgeable one, is there any way I can screen for my issue at home? I'm a low-IQ ink; I can't understand.

You shouldn't worry about this an awful lot since your surgeon will formally assess lid laxity, retraction, and vector in clinic, but that doesn't mean it is pedantry to know now, plus I know you want to mentally masturbate about what surgery you wish you could afford; I get it. Well, look no further, lost one, I shall provide you a screening/guesstimation you can do upon yourself to figure out partially what is wrong with you apart from your autism.

Hold your horses, before looking at that frauded photo of yourself you can just about stomach, I need you to man up, look at that subhuman face of yours and accept you're going to have to stare at it pretty intently for a moment. Standardisation will always prevent bad calls: a tiny head-pitch change can fraud your scleral show and canthal tilt very easily, so let's keep you far away from fixing a posture artefact with permanent surgery. A brief piece of history: in the late nineteenth century, German anthropologists came together and agreed on a common method to measure peoples' skulls and they named it the Frankfurt horizontal. This convention was formalised in Frankfurt, hence the name, and was defined as "that plane which is determined by two straight lines (one on either side of the skull), connecting the lowest points on the inferior margins of the orbits with the points of the upper margins of the bony auditory meatus (porion) situated vertically above their centres". See Figure 2.

View attachment 4212726View attachment 4212724View attachment 4212720View attachment 4212721View attachment 4212722
Figure 2: the Frankfurt horizontal/plane
​

I know you're a bit special, so to put it simply, it's a line from upper ear canal / tragion to orbitale, parallel to the floor. Although a 105mm focal length (~4.5x on modern phone lenses standing about 2.5-3m away) is ideal to best minimise perspective distortion, 2x/3x is fine if you stand closer (~1.5-2m). Now the fun part, select your desired zoom and place the camera lens at borderline eye height, level with the Frankfurt horizontal. Keep the camera square to the face, i.e. no tilt, under neutral lighting, and use a timer or a fellow subhuman to shoot. You can always crop the image later; don't step closer. Try aim for vertex-to-menton to fill ~80% of image height. This doesn't need to be done to the perfect degree or centimetre, but aiming to achieve a standardised frontal and lateral image of yourself like that of Figure 2 will be incredibly useful beyond just this thread and should be used whenever you ask a more knowledgeable inkwell for a rating or surgery recommendation.

My holy leader, I have my photos, now how do I actually know what I'm suffering from so I can match it to your divinely inspired table?

Well, my ill-featured son, you should first note that these signs often co-exist and hence certainly aren't mutually exclusive, so don't be alarmed if and when you have more than one issue.

If the lateral/external canthus appears rounded/blunted usually with an enlarged, yet dull lateral scleral triangle, you're suffering from significant horizontal laxity / lateral rounding. Rounding is almost always caused by laxity itself: it lets the angle splay and appear round; the only times I've saw this not to be the case is when someone is suffering from prior trauma, surgery, or tendon dehiscence, none of which you will have. See subhuman one in Figure 3.

View attachment 4212718
Figure 3: subhuman troon with brutal lateral rounding
​

I can already see the replies wanting to see a true -ve vector, so I'll show you one. See subhuman two in Figure 4. This chink has deathly bulging eyes; she looks like a mosquito; she also has disgraceful rims and overall malar prominence hence her -ve vector. Both the globe prominence and flat rims can and will contribute to a -ve vector, it isn't necessarily either or.

View attachment 4212719
Figure 4: noodlemaxed gook with looksmax.org-level IOs
​

Mild laxity is subtler than the prior two patterns: there's no true lateral rounding and no vertical retraction. Central lid height is normal; the lateral lid just reads a bit loose with tone loss. In this scenario, as listed earlier, the right move is a simple canthopexy which, in short, restores the snug apposition and provides a small uptick in tilt without changing eye length or corner geometry. Granny will be our example in Figure 5 below.

View attachment 4213609
Figure 5: B/A going from laterally loose to snugger apposition via canthopexy w/
corner geometry preserved
​

Beloved Chuddha, sculptor of symmetry and serenity alike, please, illuminate for us the hidden sutures of your wisdom!

Peace, my child. The path of le beauty is steep, but worry not, Chuddha aids all who reach out with trembling forceps of faith.

View attachment 4213777
​

Canthopexy is simply just a suture suspension at the end of the day. Through a small lateral incision, they expose the lateral rim periosteum at/just inside Whitnall's tubercle, as seen in Figure 6. They then pass a non-absorbable suture through the lateral tarsus/canthal tendon, and anchor it to the rim periosteum, set tension, confirm apposition, and close.

View attachment 4222754
Figure 6: orbital structure w/o soft-tissue, Whitnall's tubercle labelled​

The aesthetic effect is pretty mild: a subtle lift and tighter lateral lid without altering the canthal angle shape. Recovery is quick, swelling will resolve within a week or two, and the longest wait will be for the corner to perfectly set, and even that will only be a month or two off the table. Think of canthopexy as supportive, not shape-changing.

View attachment 4222801
Figure 7: canthopexy animation​

Lateral canthoplasty, however, is done through a small lateral canthal incision, the lower lid is released (canthotomy with inferior cantholysis), the lateral tarsus is converted into a short, bevelled tarsal strip, i.e., actual shortening, and that strip is advanced and fixed to the lateral rim at/just inside Whitnall's tubercle (recall canthopexy) with a non-absorbable suture, ideally via a drill-hole for stronger, longer-term hold, using a sort of PS vector. The lateral grey line is very precisely reformed to give a sort of V angle, preserving a small lateral scleral triangle and improving le PFL whilst tightening horizontal laxity; this is a reconstructive, shape-changing surgery, unlike canthopexy. Bloating/swelling will go in a month at most, the angle will set in a similar time frame to canthopexy, perhaps three months.

View attachment 4230735
Figure 8: canthoplasty animation (in the case of entropion)
​

A spacer graft will be performed when there's a true central height deficit (MRD2 high / excessive inferior scleral show) without a -ve IO vector rather than simple laxity. The fix is done by a thin spacer to lengthen the posterior lamella. Via a transconj. (or conservative subciliary) approach, the surgeon will release the lower-lid retractors, place a .3-.5mm beveled graft between the tarsus and retractors, secure it, then retension with canthoplasty to set the corner.

View attachment 4230754
Figure 9: incel gets graft from Eppley
​

My dear children, you now have an actionable plan beyond theory collecting. Chuddha has enlightened you all with his divine intellect. No need to panic anymore about getting an overdone tilt or given unnecessary treatments. You may now return to stimming and continuing to worship the almighty under now good, even lighting. And with that, Chuddha achieves 10,000 posts.

View attachment 4230932​

how does one increase PFL if he has epicanthus? Cases i seen with epicanthoplasty it doesnt really increased PFL and how long medial canthus was, does it have to do with shape of the orbits or the nasal bone projection(the upper part of it, between the eyes)?

this question had me haunting for months and i didnt ever saw a single good surgery result for that.

 

[ybuyhgui]

I pray Chuddha will continue to bestow his superior wisdom upon us greys in future via more threads

 

[Sicilian Cyclops]

Hi there,

Thanks a lot. Hope you enjoyed the read. There really isn't a single standard, or even safe, procedure for lowering the medial/internal canthus.

The anatomic reality of the orbitals themselves makes this quite understandable. The medial canthal tendon splits and anchors to the anterior and posterior lacrimal crests. Sitting right behind that bone is the lacrimal sac/canaliculi (your tear drain). To downturn the inner corner, you'd have to cut and re-attach the tendon lower on bone. A sort of, trans-nasal medial/internal cantho(pexy/plasty) (?), I guess. This is only reserved in trauma simply because of the risks behind it. Epiphora and webbing I believe would be quite big worries. Not to mention scarring being almost certain.

View attachment 4237107​

Doing any sort of analogous bone work medially as you would any other drill-hole is a different ballgame: you're drilling on the lacrimal system. A few mms the wrong way and you've now made a functional problem that's very hard to fix.

That bump you feel under the caruncle is usually the anterior lacrimal crest. Cosmetic shaving on it is never done: you're mms away from the lacrimal sac. Even small reductions will seriously risk instability of the lid and tearing with little pay off.

If your tilt turns +ve/neut when squinting, that'll be your clue the lid has height but lacks resting support, so you needn't operate near the tear drain / medial canthus.

Thanks for the in depth response bro. Do you think a soft tissue procedure like a Z-plasty or X to Y advancement would be a safe alternative to achieve some down turning of the canthus? I remember Eppley talking about a Z-plasty being a potential solution to this problem on his Q&A. Cheers.

 

[imontheloose]

how does one increase PFL if he has epicanthus? Cases i seen with epicanthoplasty it doesnt really increased PFL and how long medial canthus was, does it have to do with shape of the orbits or the nasal bone projection(the upper part of it, between the eyes)?

this question had me haunting for months and i didnt ever saw a single good surgery result for that.

Hey, so epicanthoplasty releases/redistributes the medial fold skin. It unmasks the caruncle, so the eye looks a bit longer medially, but the medial canthal tendon itself isn't moved. You might get net gain of perhaps 2mm apparent length at most. The medial canthal tendon is anchored to the anterior/posterior lacrimal crests right over the tear drain. Moving it is trauma-territory only. See my reply to @Sicilian Cyclops.

Real lengthening will come from your avg. canthoplasty, honestly. You're still constrained by the lateral rim and by the need to preserve a small lateral scleral triangle (over-advancing would result in an odd fish-eye look or even dryness, I can very well imagine), but its job is shape and support at the end of the day, not big length gains. Big PFL changes aren't going to happen simply due to how anatomically unsafe it is, cosmetically.

Orbital shape will set the ceiling for how far you can reposition the canthi themselves. Both ends of the fissure are tethered to the bone and critical structures.

 

[HarmonyHunter]

Mirin on the BOTB

 

[Menas]

You're on an incel forum, you need cosmetic surgery; lots of it. Many of you will be needing canthal support in particular. Fret not, Chuddha's eternal guidance is precisely what you've been longing for. Sit down and absorb, young one. Coming to the monastery on time was step one on your journey and the necessary spark in the engine.

Oh dear Chuddha, what is it exactly that we are trying to support?

View attachment 4212714
Figure 1: frontal eye anatomy​

May you now consult Figure 1, students. What we want to do to your subhuman eyes is elevate and tighten the lateral lower lid, reduce (or, ideally, erase entirely) the inferior scleral show, refine the canthal tilt, and importantly, stabilise the lid post-midface/IO work. Sounds like a lot, but you've got a hell of a lot worse you need doing, so you best strap up, son. There is a universal cosmetic standard we are after, but there are varying methods to it depending on the deformities you have. Chuddha will assist you on progressing from "what you see" → "what to do".

Understood, mighty soul, but when should we pick each tool? I'm deformed and giga-retarded.

I know you are, son. Fear not, Chuddha shall provide you a format of which each issue will be addressed: core problem(s) → primary tool → typical add-ons.

• mild lateral laxity / prophylaxis for midface or IO implants → lateral canthopexy → (+) orbicularis hitch if dynamic laxity.
• moderate lateral laxity (lower lid is too long/loose laterally) or lateral rounding / early ectropion → tarsal-strip canthoplasty → (+) drill-hole fixation if periosteum is weak.
• vertical lower-lid retraction (inferior scleral show) → spacer graft (usually from thin HPM/auricular) + canthoplasty → (+) SOOF/midface suspension if lid-cheek distance is long or midface descent contributing, not exclusively because of a -ve vector per se. If -ve vector, follow the below pathway instead.
• -ve vector undergoing rim/IO augmentation → canthopexy or canthoplasty + SOOF/midface suspension + orbicularis hitch.
• medial laxity/telecanthus (very rare cosmetically, but some of your deformities genuinely surprise me, so I will not rule anything out) → medial canthopexy.

Oh knowledgeable one, is there any way I can screen for my issue at home? I'm a low-IQ ink; I can't understand.

You shouldn't worry about this an awful lot since your surgeon will formally assess lid laxity, retraction, and vector in clinic, but that doesn't mean it is pedantry to know now, plus I know you want to mentally masturbate about what surgery you wish you could afford; I get it. Well, look no further, lost one, I shall provide you a screening/guesstimation you can do upon yourself to figure out partially what is wrong with you apart from your autism.

Hold your horses, before looking at that frauded photo of yourself you can just about stomach, I need you to man up, look at that subhuman face of yours and accept you're going to have to stare at it pretty intently for a moment. Standardisation will always prevent bad calls: a tiny head-pitch change can fraud your scleral show and canthal tilt very easily, so let's keep you far away from fixing a posture artefact with permanent surgery. A brief piece of history: in the late nineteenth century, German anthropologists came together and agreed on a common method to measure peoples' skulls and they named it the Frankfurt horizontal. This convention was formalised in Frankfurt, hence the name, and was defined as "that plane which is determined by two straight lines (one on either side of the skull), connecting the lowest points on the inferior margins of the orbits with the points of the upper margins of the bony auditory meatus (porion) situated vertically above their centres". See Figure 2.

View attachment 4212726View attachment 4212724View attachment 4212720View attachment 4212721View attachment 4212722
Figure 2: the Frankfurt horizontal/plane
​

I know you're a bit special, so to put it simply, it's a line from upper ear canal / tragion to orbitale, parallel to the floor. Although a 105mm focal length (~4.5x on modern phone lenses standing about 2.5-3m away) is ideal to best minimise perspective distortion, 2x/3x is fine if you stand closer (~1.5-2m). Now the fun part, select your desired zoom and place the camera lens at borderline eye height, level with the Frankfurt horizontal. Keep the camera square to the face, i.e. no tilt, under neutral lighting, and use a timer or a fellow subhuman to shoot. You can always crop the image later; don't step closer. Try aim for vertex-to-menton to fill ~80% of image height. This doesn't need to be done to the perfect degree or centimetre, but aiming to achieve a standardised frontal and lateral image of yourself like that of Figure 2 will be incredibly useful beyond just this thread and should be used whenever you ask a more knowledgeable inkwell for a rating or surgery recommendation.

My holy leader, I have my photos, now how do I actually know what I'm suffering from so I can match it to your divinely inspired table?

Well, my ill-featured son, you should first note that these signs often co-exist and hence certainly aren't mutually exclusive, so don't be alarmed if and when you have more than one issue.

If the lateral/external canthus appears rounded/blunted usually with an enlarged, yet dull lateral scleral triangle, you're suffering from significant horizontal laxity / lateral rounding. Rounding is almost always caused by laxity itself: it lets the angle splay and appear round; the only times I've saw this not to be the case is when someone is suffering from prior trauma, surgery, or tendon dehiscence, none of which you will have. See subhuman one in Figure 3.

View attachment 4212718
Figure 3: subhuman troon with brutal lateral rounding
​

I can already see the replies wanting to see a true -ve vector, so I'll show you one. See subhuman two in Figure 4. This chink has deathly bulging eyes; she looks like a mosquito; she also has disgraceful rims and overall malar prominence hence her -ve vector. Both the globe prominence and flat rims can and will contribute to a -ve vector, it isn't necessarily either or.

View attachment 4212719
Figure 4: noodlemaxed gook with looksmax.org-level IOs
​

Mild laxity is subtler than the prior two patterns: there's no true lateral rounding and no vertical retraction. Central lid height is normal; the lateral lid just reads a bit loose with tone loss. In this scenario, as listed earlier, the right move is a simple canthopexy which, in short, restores the snug apposition and provides a small uptick in tilt without changing eye length or corner geometry. Granny will be our example in Figure 5 below.

View attachment 4213609
Figure 5: B/A going from laterally loose to snugger apposition via canthopexy w/
corner geometry preserved
​

Beloved Chuddha, sculptor of symmetry and serenity alike, please, illuminate for us the hidden sutures of your wisdom!

Peace, my child. The path of le beauty is steep, but worry not, Chuddha aids all who reach out with trembling forceps of faith.

View attachment 4213777
​

Canthopexy is simply just a suture suspension at the end of the day. Through a small lateral incision, they expose the lateral rim periosteum at/just inside Whitnall's tubercle, as seen in Figure 6. They then pass a non-absorbable suture through the lateral tarsus/canthal tendon, and anchor it to the rim periosteum, set tension, confirm apposition, and close.

View attachment 4222754
Figure 6: orbital structure w/o soft-tissue, Whitnall's tubercle labelled​

The aesthetic effect is pretty mild: a subtle lift and tighter lateral lid without altering the canthal angle shape. Recovery is quick, swelling will resolve within a week or two, and the longest wait will be for the corner to perfectly set, and even that will only be a month or two off the table. Think of canthopexy as supportive, not shape-changing.

View attachment 4222801
Figure 7: canthopexy animation​

Lateral canthoplasty, however, is done through a small lateral canthal incision, the lower lid is released (canthotomy with inferior cantholysis), the lateral tarsus is converted into a short, bevelled tarsal strip, i.e., actual shortening, and that strip is advanced and fixed to the lateral rim at/just inside Whitnall's tubercle (recall canthopexy) with a non-absorbable suture, ideally via a drill-hole for stronger, longer-term hold, using a sort of PS vector. The lateral grey line is very precisely reformed to give a sort of V angle, preserving a small lateral scleral triangle and improving le PFL whilst tightening horizontal laxity; this is a reconstructive, shape-changing surgery, unlike canthopexy. Bloating/swelling will go in a month at most, the angle will set in a similar time frame to canthopexy, perhaps three months.

View attachment 4230735
Figure 8: canthoplasty animation (in the case of entropion)
​

A spacer graft will be performed when there's a true central height deficit (MRD2 high / excessive inferior scleral show) without a -ve IO vector rather than simple laxity. The fix is done by a thin spacer to lengthen the posterior lamella. Via a transconj. (or conservative subciliary) approach, the surgeon will release the lower-lid retractors, place a .3-.5mm beveled graft between the tarsus and retractors, secure it, then retension with canthoplasty to set the corner.

View attachment 4230754
Figure 9: incel gets graft from Eppley
​

My dear children, you now have an actionable plan beyond theory collecting. Chuddha has enlightened you all with his divine intellect. No need to panic anymore about getting an overdone tilt or given unnecessary treatments. You may now return to stimming and continuing to worship the almighty under now good, even lighting. And with that, Chuddha achieves 10,000 posts.

View attachment 4230932​

Thank you Chuddha

 

[imontheloose]

Thanks for the in depth response bro. Do you think a soft tissue procedure like a Z-plasty or X to Y advancement would be a safe alternative to achieve some down turning of the canthus? I remember Eppley talking about a Z-plasty being a potential solution to this problem on his Q&A. Cheers.

You're very welcome!

A Z-plasty / X-Y at the medial canthus can change the skin shape a little I suppose, but again, it won't lower the medial canthal tendon. It can create a slight downturned look, but it isn't a true inferior reposition of the canthus which you should note.

The way a Z-plasty works and why it very well could help is because they transpose small triangular flaps along the epicanthal fold. Doing so allows you to reorient skin tension and expose more inferior-medial caruncle which visually pulls the inner corner down a tad. Perhaps a mm, I imagine. Tolerance of a touch more/less included, of course. It's essentially a variant of medial epicanthoplasty with an inferior bias. If the issue is true canthal height, soft-tissue flaps won't fix it. Tendon reposition = medial canthoplasty (trauma-territory) with real risks to the lacrimal system.

I will still warn against scarring or notching even with skin-only. An over-zealous inferior pull can actually give you a rounded inner angle too, but you should be rest assured with Eppley's opinion on that: he is quite a fair thinker and is more open-minded than others.

So long as it's carefully designed, it will downturn the appearance by redraping the skin. Eppley will run you through expectations since it's scar-dependant.

 

[imontheloose]

I pray Chuddha will continue to bestow his superior wisdom upon us greys in future via more threads

Chuddha reads this with joy on his face.

Mirin on the BOTB

Thanks a lot!

Thank you Chuddha

View attachment 4237256

You are very welcome, my child.

 

[Soter]

This thread is about canthal support not the aesthetics of the entire orbit. Almost all canthopexies, and canthoplasties for that matter, will be done with other work because addressing the entire eye is more than just the lateral canthus. In fact, I mentioned in this very thread the likelihood of multiple issues being present regarding the lateral canthus and lid laxity alone.

Your argument is disingenuous. Does wheel alignment not matter as a whole because some cars need a new engine? Different problems live at different layers. At the end of the day, canthal support is very important for the eye's aesthetics and after IO work, they will always consider it. Even after fat grafts they like to add support.

ROI is diagnosis-dependant, not universal. For the right indication, canthal support is a high-yield interest for a patient. In fact, prophylaxis itself is ROI. You don't want postoperative descent/ectropion I would hope.

To fix an eye area, the blueprint is simple, foundation first, then mechanics (pexy/strip +/- spacer), then envelope (fat/bleph). Each step solves a different failure mode. Skipping mechanics and piling on envelope work is how you look more funky than the town.

Thank you, Lord Chuddha. Now I understand.

Does postoperative descent/ectropion only occur with implants? I was thinking about getting fat grafts first for my undereye hollowness. The main problem I'm trying to fix is the harsh transition between the malar region and the lower eyelid. It's especially pronounced when the cheek is pushed upwards like while smiling. I was hoping that the fat graft might even slightly push up the lower eyelid into a more permasquintmaxxed position. Would I still need eyelid surgery?

 

[imontheloose]

Thank you, Lord Chuddha. Now I understand.

Does postoperative descent/ectropion only occur with implants? I was thinking about getting fat grafts first for my undereye hollowness. The main problem I'm trying to fix is the harsh transition between the malar region and the lower eyelid. It's especially pronounced when the cheek is pushed upwards like while smiling. I was hoping that the fat graft might even slightly push up the lower eyelid into a more permasquintmaxxed position. Would I still need eyelid surgery?
View attachment 4237274

You're more than welcome, my child.

No, it's not only with implants. It's a mechanics problem, so it can happen after lower-blephs, lifts, and implant cases. Implants result in slightly more risk mainly because they require rim dissection and swelling that drags on a lax lid.

Fat grafting won't push the lower lid up. Fat fills a hollow; it doesn't create PS support or tighten the canthus. In a -ve vector case, the fat will just droop / look heavy.

From your photo, you look IO/malar deficient, that harsh lid-cheek step is a classic not enough bony support, not a fat-only problem. Build support, add canthal support to protect the lid then use small volume fat for the last touch of blending. Simple.

 

[yussimania]

If your tilt turns +ve/neut when squinting, that'll be your clue the lid has height but lacks resting support, so you needn't operate near the tear drain / medial canthus.

chudda can you please elaborate on the squinting part, my eyes are neutral but when i squint they go negative.

normal resting:

squinting/frowning:

 

[imontheloose]

chudda can you please elaborate on the squinting part, my eyes are neutral but when i squint they go negative.

normal resting:

View attachment 4237390
View attachment 4237391

squinting/frowning:

View attachment 4237405
View attachment 4237423
View attachment 4237406

Hi there, that's just the fat pad making it appear that way by covering up the eye via a -ve gradient, not the lateral canthus itself changing.

 

[Soter]

From your photo, you look IO/malar deficient, that harsh lid-cheek step is a classic not enough bony support, not a fat-only problem. Build support, add canthal support to protect the lid then use small volume fat for the last touch of blending. Simple.

I find it really hard to imagine what it would look like post ops

 

[imontheloose]

I find it really hard to imagine what it would look like post ops

It's very hard for me to tell you virtually how you're going to look. You'll have far clearer expectations in clinic after a consult.

 

[Soter]

It's very hard for me to tell you virtually how you're going to look. You'll have far clearer expectations in clinic after a consult.

yeah but I feel like a fat graft alone would help a lot, it's hard to judge the ROI of implants+canthus support+fat grafts, it seems like a negligible increase in PSL compared to the incurred costs

 

[imontheloose]

yeah but I feel like a fat graft alone would help a lot, it's hard to judge the ROI of implants+canthus support+fat grafts, it seems like a negligible increase in PSL compared to the incurred costs

It appears to be a bone problem from the limited view I have. I'd need a full lateral to better conclude. As I already stated, hiding bone with fat is disastrous.

 

[DR. NICKGA]

I got tagged

 

[yussimania]

Hi there, that's just the fat pad making it appear that way by covering up the eye via a -ve gradient, not the lateral canthus itself changing.

View attachment 4237430View attachment 4237431

I also find my other eye droops quite a bit compared to the one you highlighted here. Is that a case for a canthopexy to tighten the lower lid? Also do you think the i should get a bleph to address the excess fat? Thanks Chudda

 

[DR. NICKGA]

GOOD thread sir, great work

 

[imontheloose]

I also find my other eye droops quite a bit compared to the one you highlighted here. Is that a case for a canthopexy to tighten the lower lid? Also do you think the i should get a bleph to address the excess fat? Thanks Chudda

Looks like it, yes. Albeit subtle, it will help. Pexy is usually combined with other work, else you'd normally opt for a standard tarsal. You can get a bleph, sure.

 

[DR. NICKGA]

 

[Sadist]

magnificent narrative, mr chuddha

 

[imontheloose]

GOOD thread sir, great work

View attachment 4237498

View attachment 4237508

magnificent narrative, mr chuddha

Thank you both very, very much! Chuddha is glad you enjoyed the read.

 

[Saint Casanova]

What a thread, wow.

 

[imontheloose]

What a thread, wow.

Thank you very much, pirate mogger.

 

[Mess]

Oh great lord Chuddha will reward me with undereye support eventually.

 

[imontheloose]

Oh great lord Chuddha will reward me with undereye support eventually.

Verily he will, my child.