Case Background: The Necessity of Inner Canthus Revision

The inner canthus surgery (epicanthoplasty) is a common procedure in oculoplastic surgery. However, due to the complex anatomical structure of the inner canthus area, high skin tension, and a significant tendency for scar hyperplasia, improper design or rough execution during the initial surgery can easily result in poor morphology or functional issues. This case shares the experience of a patient seeking revision for their inner canthus, aiming to explore how refined techniques can improve problems left by previous surgeries.

Preoperative Assessment: Analysis of Main Issues

During the consultation, we conducted a detailed assessment of the patient's eye condition and identified the following typical indications for revision:

Prominent Scarring and Adhesion: Distinct linear scars were present at the original incision site, accompanied by local tissue adhesion. This resulted in a stiff appearance of the inner canthus, lacking natural physiological curvature.
Morphology Too Sharp or Blunt: Errors in judging the amount of tissue removal during the initial surgery led to an inner canthus that was either too sharp, appearing harsh, or too blunt due to retraction. The expected widening effect was not achieved.
Over- or Under-exposure of the Caruncle: The exposure ratio of the red caruncular tissue was disproportionate, affecting the aesthetic appeal of the eyes' expression and even causing mild dry eye discomfort.
Asymmetry: Visible differences existed in the height, angle, and morphology of the bilateral inner canthi, impacting the overall coordination of facial features.

Revision Strategy: Refined Reconstruction

Addressing the aforementioned issues, revision surgery is not merely a "re-incision" but a reconstruction based on anatomical layers. Our core strategies include:

Adhesion Release and Scar Trimming: Precise dissection of subcutaneous adhesions and excision of undesirable scars to release skin tension, creating space for reshaping a natural morphology.
Adjustment of Flap Design: Redesigning the flap trajectory based on the patient's eyelid skin laxity and brow-eye distance. Employing suture methods that align more closely with physiological structures to avoid the formation of tractional scars.
Moderate Tissue Preservation: Adhering to the principle of "less is more," carefully handling the medial canthal ligament and surrounding soft tissues. Ensuring an appropriate exposure ratio of the caruncle (typically suggested between 30%-50%) to balance aesthetics with the maintenance of ocular moisture function.
Bilateral Symmetry Adjustment: Using the better side as a reference or making fine-tuned adjustments to both sides to strive for high symmetry in postoperative eye morphology, angle, and height.

Postoperative Recovery and Effect Feedback

The recovery period for inner canthus revision surgery is usually slightly longer than that of the primary surgery, as it requires waiting for deep tissue softening and scar stabilization.

In the early postoperative stage (1-3 months), slight swelling and induration may occur locally, which is part of the normal healing process. By following medical advice regarding anti-scar medications and regular follow-ups, most patients see their scars gradually fade and soften within 3-6 months post-surgery, with the inner canthus morphology becoming natural and smooth. In this case, upon the six-month postoperative follow-up, the patient exhibited a gentle inner canthus morphology, no obvious scar hyperplasia, good bilateral symmetry, and a more lively and natural gaze, achieving the expected revision goals.

Doctor's Message

Inner canthus revision is a surgery requiring extremely high technical skills from the physician, testing not only aesthetic sense but also precise mastery of ocular anatomical layers. It is recommended that patients seeking revision carefully review the doctor's past authentic revision cases, fully communicate expected outcomes, and maintain reasonable psychological expectations. The purpose of revision is improvement and optimization, rather than pursuing flawless perfection; natural harmony represents the advanced realm of medical aesthetics.

Jiangnan SECRET Plastic Surgery DermatologyEnvironment