Cosmetic eye surgery with lateral canthopexy for antimongoloid slant correction
Presentation of antimongoloid slant and its occurrence A downward slant from the medial canthus to the lateral canthus of the eye is termed as an antimongoloid slant. It is the direct opposite of the mongoloid slant where the downward slant is from the lateral to the medial canthus of the eye. It can be idiopathic in nature or can occur as a part of a syndromic presentation including as a part of Treacher-Collins syndrome and Franceschetti syndrome. An eyelid surgery is performed to correct this. Characteristics of the antimongoloid slant in eyes Patients who have an antimongoloid slant to their eyes have no functional deficits to their eyes. It is only when patients are uncomfortable with the esthetic appearance of their eyes do they opt for surgical correction of this condition. Subtle body language cues that can alter the very meaning of spoken words Human communication can be divided into two components. One is verbal and the other is nonverbal cues. You would notice that when a person talks to another, they use their mouth to articulate the words, but special emphasis is laid to nonverbal communication through the use of hand movements and eye movements. Subtle differences brought about by nonverbal cues can change the entire tone of the communication even if the words remain unchanged. Rationale behind opting for cosmetic eye surgery in the modern world When one feels uncomfortable with the appearance of their eyes, this makes them feel very self conscious. This immediately leads to a sense of awkwardness that impedes effective communication. Communication is the tool through which we make a mark on the world around us. When this is affected by any factor, our very growth and integration into the community around us, whether at home or at the workplace is affected. Care has to be taken by the surgeon to ensure that the functional integrity of the eyes is not compromised by this surgery. This is a completely elective eye surgery on the patient’s part to undergo this surgical procedure. Removing excess skin is performed in case of wrinkles in the skin in older patients in order to make the skin tauter. Procedural description of corrective eye surgery A form of brow lift is performed for this correction. Excess skin muscle if present is carefully excised before taking deep bites from the eyelid and eyebrow and suturing to the periosteum. Sagging skin under the eyes is also tightened as a secondary benefit arising from this procedure. The appearance of having droopy eyelids is corrected completely giving the patient a completely level gaze. Care should be taken to not impair vision in any way. Lateral canthopexy surgery is one of the most commonly performed procedures of blepharoplasty in India. This is classified under brow lift surgery procedures. Cosmetic surgery is undergoing a boom throughout the world. India in particular is fast turning into a hub for cosmetic eye surgery, cosmetic nose surgery and overall cosmetic face surgery in the world. Patient with antimongoloid slant is referred to our hospital for cosmetic eye surgery The patient is a young man with idiopathic antimongoloid slant of the eye. He hated the way his eyes appeared. His marriage got fixed recently and he finally decided to get the slant corrected. He approached a local plastic surgeon at a cosmetic eye center in his hometown who referred him to our hospital for correction of his antimongoloid slant as we are a specialty center for cosmetic eye surgery in India. Initial examination and treatment planning for the patient Dr SM Balaji, cosmetic eye surgeon, examined the patient and ordered detailed biometric studies including measurements for the golden ratio. He explained to the patient that he needed a lateral canthopexy for correction of his antimongoloid slant. This is a procedure that has the approval of the American Society of Plastic Surgeons for the correction of antimongoloid slant. The patient was in agreement with the treatment plan and consented for surgery. He explained that this procedure gave the best results for correcting the antimongoloid slant. The patient was informed that the decision might be made to remove excess skin if the need arose during surgery. Surgical correction of antimongoloid slant of the eyes Under general anesthesia, the patient was prepped and draped for surgery. Cosmetic eye correction surgery for antimongoloid slant of the right eye was performed first. An incision was made at the lateral canthus and extended outwards. The incision was then extended along the margins of the upper eyelid and also the lower eyelid. A suture was passed through the edge of the lower eyelid and secured to the periosteum of the orbital margin. The incision was then closed in layers using sutures to ensure minimal scar formation. This resulted in bringing the medial and lateral canthal margins to the same horizontal plane. Good esthetic results with symmetry of repositioned eyelids The same procedure was next performed on the left eye. Perfect symmetry of the eyes was ascertained at the end of the procedure. Care was taken to ensure that the eyes were never dry during any portion of the procedure. General anesthesia was reversed and the patient recovered without incident after the surgery. The patient expressed complete satisfaction at the results of the surgery before final discharge from the hospital. Surgery Video
Cosmetic Eye Surgery for Bilateral Antimongoloid Slant Correction
Occurrence of antimongoloid slant of the eyes The shape of the eye and the eyelids is heavily influenced by genes. Each race is characterized by a particular eye and eyelid form. When the nasal corner of the palpebral fissure is higher than the temporal corner, it gives rise to an antimongoloid slant to the eyes. This is a genetic feature and is heavily influenced by hereditary factors. It is manifested by a slight downward slant to the lateral upper eyelids. This gives the eyes the typically narrow appearance. Mongoloid slant to the eyes explained in detail It is the opposite of the mongoloid slanting of the eyes where the temporal corner of the palpebral fissure is at a higher level than the nasal corner. This is a racial characteristic that is found amongst the Chinese, Japanese, Malay and other similar races. Mongoloid slant to the eyes is a prominent finding in Down’s syndrome. Down’s syndrome is also known by the term mongolism. The other features of Down’s syndrome include short stature, flat face and mental retardation. Down’s syndrome is not a genetic disorder, but occurs due to a random mutation during the cell division phase of fetal development. Certain syndromes that have a presentation of antimongoloid slant to the eyes also feature mental retardation amongst the constellation of symptoms associated with it. Syndromes associated with antimongoloid slant to the eyes Certain syndromes give rise to an antimongoloid slant of the eyes. These include Tarsal Tunnel, Cri Du Chat, gigantism, Curry Hall, Weaver, Waisman, Pallister, Noonan, Charge and Treacher-Collins syndromes. Antimongoloid slant of bilateral eyes appears as one amongst a constellation of features in these syndromes. However, this patient did not display any syndromic presentation. His antimongoloid slant of the bilateral eyes occurred in complete isolation. This could be due to an isolated genetic mutation or could be the result of hereditary transference from a distant ancestor. Patient with the complaint of antimongoloid slant to the eyes This patient had an antimongoloid slant due to the downward slant of his bilateral lateral eyelids. This led to a myopic or drooping appearance to his eyes. He felt uncomfortable with his appearance because of this. A friend recommended that he undergo cosmetic eye surgery to correct this. The patient presented to a local board certified plastic surgeon who referred him to our hospital. Presentation at our hospital for cosmetic eye surgery for antimongoloid slant correction Our hospital is a well known center for facial reconstructive surgery in Chennai. Dr SM Balaji examined the patient and explained that the patient needed plastic surgery similar to a brow lift procedure. He explained that the principle was the same as breast augmentation surgery. The technique used would be the same that was used to make sagging skin taut. The difference was that the tautening the skin involved removing excess skin. This however was not a case of excess eyelid skin. This was an anatomical variation that presented in approximately 0.5% of the population. He said that droopy eyelids involved both upper and lower eyelids. It was illustrated to the patient that a downward tilt of the lateral upper lids of the eyes gave the antimongoloid appearance. This is a purely cosmetic procedure and has no functional aspect to it. Principles of cosmetic eye surgery explained to the patient The principle behind face lifts would be utilized to correct the antimongoloid slant. He said that the patient needed a facial cosmetic surgeon and referred him to our hospital. The cost of facial cosmetic surgery in India is very economical compared to the developed countries in the west. Facial plastic surgery in India is highly developed and very advanced due to the high demand. These surgery procedures are very commonly performed nowadays. It is a combination of these factors that had led to the explosion in medical tourism to India. Cosmetic surgical procedures feature at the top of the list for medical tourism to India. Highly skilled medical professionals allied with excellent infrastructure provide very good results for the patients. Patient presents for facial cosmetic surgery Dr SM Balaji, a well known facial cosmetic surgeon in India, next ordered a series of biometric studies as these surgical procedures demand a high degree of precision. Decision was made to perform cosmetic eye surgery. He made detailed measurements of the needed corrections. The surgery was then explained in detail to the patient. Patient agreed to the surgery and provided his consent. Surgical correction of antimongoloid slant of the eyes Under conscious sedation, a right lateral upper eyelid crease incision was first made. A fine Prolene suture was then used to suture the underlying tissues of the eyelid to the periosteum of the lateral orbital bone. Elevation of the lateral eyelid resulted in correction of the antimongoloid slant of the eye. Same procedure was then repeated on the left eye with similar results. The patient expressed total satisfaction at the results of the surgery. Surgery Video