Can My Inner Eyes Be Lengthened?

Q: Dr. Eppley, I have a couple questions about my eye area:

1. The first two pictures show my current eye area completely relaxed. Do I have ptosis of the upper or lower eyelid? If not, would ptosis surgery or any other procedure work to lift my lower or upper eyelids a bit?

2. One of my desired outcomes is moving the inner corners of my eyes a couple millimeters inward, as shown in picture 3 as a slight morph of the second picture. I notice I get this result when I pull very slightly with my fingers inward, and the eyelids still remain attached to the eyeball. This makes me think I have loose skin or medial canthal tendons. I have seen mixed opinions online, and you stated in a post that this would be difficult to achieve without risking scarring. Suppose we didn’t really care about scarring. I have seen procedures designed to achieve this effect, such as C-U plasty (picture 4), which cuts the medial canthal tendon and moves one end inward, as shown in picture 6, and W-V plasty, which simply removes some skin to tighten the area. These generally are designed to correct telecanthus. Would one of these procedures, or any other ones that tighten skin or the tendons, realistically work for my case?

A:In answer to your eye reshaping questions:

1)Do you have true ptosis….not really. Maybe a 1mm. But one does not have to have true ptosis to have ptosis (upper lid elevation) surgery.

2) Lengthening the inner eye corner towards the nose is not done by any medial canthal tendon surgery or any of the procedural diagrams which you shown. (those are for webbing/hypertelorism surgeries) It is done  by a tissue rearrangement technique known as a Y-V lengthening surgery. This has more favorable scar formation than its cousin, V-Y narrowing.

Dr. Barry Eppley

World-Renowned Plastic Surgeon