Lateral canthoplasty — what was moved reattaching is this operation's characteristic problem

Lateral canthoplasty widens the outer corner of the eye to lengthen it.

First it has to be separated from epicanthoplasty. The two are named together but work on different things.

• epicanthoplasty — releases the epicanthal fold (a fold of skin) at the inner corner
• lateral canthoplasty — at the outer corner, moves the place where the lids are anchored to bone

That difference sets the nature of the result. Releasing skin and moving an anchor are not the same. What has been moved is under force to go back.

So this operation carries a word rare among the surgery pages here — reattachment. The only places this site uses that idea are otoplasty and here.

And it is often done together with other eye operations: double eyelid, ptosis correction, epicanthoplasty. When several are done at once, it is hard afterwards to tell which one produced the result. That is set out below.

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Reattachment is this operation's most characteristic problem. As the moved corner heals, it can bind back towards where it started. Losing some of the width gained, over time, is not rare. Ask before surgery how often it goes back, and what is done then.

Revising it is hard. Moving an already-scarred corner again layers scar on scar, and the second time is harder than the first. That is why 'a little' matters in this operation.

The eye can end up looking downturned. Moving the outer corner downwards can read as sad or older. A decision about the vertical changes the impression more than one about the horizontal.

More of the white shows. That is partly the point, but taken too far the eye dries and stings, because tears no longer spread evenly.

Tear drainage and the direction tears run can change. Pooling and overflow are reported.

If the way the conjunctiva is exposed changes, a gritty feeling and redness can persist.

A scar remains outside the outer corner. It is short and usually falls into the line of the eye, but if your scars tend to widen, it can show there.

The two sides will not end up identical. Eyes differ in length and angle to begin with.

Swelling lasts months. The result cannot be judged from the early appearance, and deciding during that time that 'it did not open enough' and having more done is the dangerous move.

Establish first why the eye reads as short. An outer corner that is genuinely short, an eye that looks small because it does not open well (the territory of ptosis correction), and an inner corner that is covered (the territory of epicanthoplasty) are different. Different causes, different operations.

Ask which direction the corner will be moved. Outwards only, or downwards as well. How far it goes downwards changes the impression most.

Talk in terms of 'a little'. In an operation that can go back, moving a lot is risky in two directions: it can look overdone, and the more it was moved the more it can revert.

If you are planning several eye operations at once, get a separate explanation of what each is for. Doing them together means one recovery, but if you dislike the result it is hard to tell which one caused it.

If your eyes tend to be dry, say so in advance. This operation increases the exposed area.

Check photographs from the front, the side, and smiling. The outer corner moves most when you smile.

Not smoking helps. It affects how fast the area around the eye heals.

This page marks reversibility as 'permanent'. Surgery to put a moved anchor back is difficult and cannot promise a result. Part of it drifting back against intention is a separate matter, under cautions above. This operation is the rare combination of 'cannot be undone' and 'can undo itself'.

It is a judgement in millimetres. And those millimetres change the impression. Agreeing it in advance from photographs is especially hard here.

Eyes are read together with the rest of the face. Moving only the outer corner changes how it relates to brows, cheekbones and the width of the face.

Judgements about impression vary with culture and fashion. This site does not say which eye shape is good. It says what changes, and which of those changes cannot be undone.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.