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Horizontal Enlargement

Horizontal eye enlargement is a commonly performed procedure in South Korea and is often simultaneously performed with the double eyelid surgery. Horizontal eye enlargement is the medial and/or lateral enlargement of the eyes which is performed by two techniques: (1) epicanthoplasty and (2) lateral canthoplasty. In order to create aesthetically beautiful eyes, the eyes have to be an appropriate size in relation to its shape. In some cases, this cannot be accomplished solely by removing the excessive skin hooding of the eyelids or creating a double eyelid crease.

It is a common misconception that larger eyes are achieved simply by double eyelid surgery itself.

When necessary, a patient may also have to undergo horizontal eye enlargement to create the evenly shaped, larger eyes they desire.

EPICANTHOPLASTY

For Asians with an epicanthal fold (a skin fold of the upper eyelid covering the inner corner of the eye), the inner corners of their eyes are sharp. Epicanthoplasty is performed to remove the epicanthal folds, thus giving the eyes softer inner corners. Eighty to ninety percent of patients with this epicanthal fold who undergo double eyelid surgery, elect to have epicanthoplasty as well. If a patient with epicanthal fold receives the double eyelid surgery without the epicanthoplasty, the eyes appear too round in shape while the double eyelid crease is short with a sharp inward curve. Epicanthoplasty is commonly performed with double eyelid surgery as the presence of an epicanthal fold can hinder the formation of the new double eyelid fold from occurring medially.

One drawback of epicanthoplasty is that it can leave visible post-surgical scar lines. Today, newer methods such as magic/tissue repositioning or diamond-shaped epicanthoplasty have been devised to decrease scar formation. Both of these techniques rely on tension-free closure which have addressed the significant scarring that occurred in the past.

After epicanthoplasty, it is imperative that the patient does not apply pressure onto this area (e.g., via makeup and makeup removal) since this can aggravate the tissues in the area, causing scars to form. For the first 3-4 months following surgery, the epicanthoplasty scar tends to be red and visible; however, after 9 months, these conditions improve.

Whether a patient should or should not undergo epicanthoplasty depends on the patient’s eye shape and the professional judgment of the performing surgeon. If a patient’s epicanthal fold significantly impedes the natural fold formation at the medial or nasal aspect of the eyelid, epicanthoplasty is highly recommended. Another method is clinically pulling on the nasal aspect of the eyelid and determining the fold formation and aesthetics of the eye with this maneuver. It is important that the surgeon pull nasally and upwardly in an oblique fashion. It is the upper inner side that is obstructing the double eyelid fold from tapering smoothly. Together, the surgeon and the patient can see how the fold and eye shape would appear with and without the epicanthoplasty. If properly diagnosed and performed, tension-free epicanthoplasty results can be exceptional.

LATERAL CANTHOPLASTY

Lateral canthoplasty is a procedure of the enlargement of the lateral aspects or outer aspects of the eyes.

The lateral, or the outer tilt of the eyes, is an important element in the creation of aesthetically beautiful eyes. In general, Asian faces are larger in proportion to their smaller sized eyes; therefore, extending the eyes creates more proportionality of the face. The increase may be subtle as it is a matter of a few millimeters (e.g., 2-3mm); however, the effects are noticeable to the overall appearance. The ideal eye dimensions also include a slight upward tilt in the lateral part of the eyes. For women, this upward tilt should be 2-4mm higher relative to the nasal side of the eye. For men, the lateral end should be positioned evenly to the nasal side, if not 1-2mm higher.

Additionally, the amount of sclera, or the white part of the eye, shown significantly contributes to how feminine one may appear. In general, a more aesthetically pleasing eye has even or a greater amount of sclera shown on the outer side compared to the nasal/medial side of the eye. For women, slight increase in the appearance of lateral scleral can bring out a more feminine look. Therefore, the lateral canthoplasty not only provides a softer touch to the eyes, it also engenders a more feminine look.

Modern Advancements

Traditionally, the lateral canthoplasty procedure only allowed for the opening up of the outer aspect of the eyes, making them look larger.

Modern advancements in lateral canthoplasty not only widen the eyes laterally, but also alter the tilt of the eyes.

Furthermore, traditional lateral canthoplasty was fraught with recurrence and the eyelids would revert back to its original state. The traditional method is performed by simply cutting the lateral aspect of the eye and leaving it open to heal. Because the wounds are left open, it is the body’s natural reaction to close and heal an open wound. To combat this tendency of the body, the newer, more advanced technique of lateral canthoplasty involves the reconstructing of the outer aspects of the eyes by reconstructing the edges, so there is no minimal incidence of adhering back.

Some patients may not benefit as much from lateral canthoplasty. Patients with outer orbital bones that are closer in distance will not gain significant length with this procedure. Additionally, there are rare cases where patients have a large proportion of the white aspect on the lateral side of their eyes and should avoid undergoing this procedure, as it will result in greater disproportion of the white aspect on the lateral side of the eyes.