Ideal anatomy and proportions:
A young eye is defined by an eyebrow in an ideal position to the eyebrow lift, a deep and well-defined upper crease that does not come into contact with the eyelashes (distance from crease to eyelashes: 8-10 mm, distance from upper crease to eyebrow: 12-16 mm), and a smooth lower eyelid without hollows or pockets. The orientation of the eye (canthal tilt) must be neutral or positive: slightly rising towards the temples (lateral canthus 1-2 mm above medial canthus).
Either constitutionally or with age, the canthal tilt can be negative, giving a tired appearance and closing the eyes. The positivity of the canthal tilt is one of the criteria of youthfulness of the eyes.
There are different techniques to positivize the tilt canthal: either surgical or with resorbable threads.
Cat eyes Technique:
Concerning the technique with threads: these resorbable threads made of PDO (= polydioxanone) have teeth that hook the superficial subcutaneous tissue and thus apply a traction force. They are inserted through micro-incisions (0.5 mm), run in tunnels under the skin to the scalp and the tension is adjusted to bring the corner of the eye up. The procedure is performed under local anesthesia, the secret is to make a long tunnel so that the wire has a better grip and lasts longer and to anesthetize the entire tunnel path for maximum patient comfort, the procedure takes 45 to 60 minutes.
Lateral canthus
Concerning the surgical technique, it is a matter of pulling the lateral canthus with non-absorbable threads, either through an 8 mm scar at the corner of the eye, or through a 3- 4 cm scar hidden in the hair above the temple, and thus fix this thread to the bone in a solid way.
Results:
Final results :
Concerning the tensor threads: After a social eviction of 24 – 48 hours, one can immediately see the result with a hypercorrection of 2-3 mm then to see the definitive result it is necessary to wait approximately 1 week.
Concerning the surgery:
After a social eviction of 7 -10 days, one can immediately see the result with a hypercorrection of 2-3 mm then to see the definitive result it is necessary to wait 2-4 weeks approximately.
Longevity of results :
Tensor threads: 3- 15 months
Surgery: 5-10 years
Before surgery:
Stop smoking 1 month before surgery
Do not take Aspirin 10 days before surgery, inform Dr. Lucas of any anticoagulant medication (Sintrom, Coumadin, Eliquis, etc..) to arrange for its discontinuation or replacement.
Take Arnica capsules 5 capsules 5 times a day for 5 days before surgery to prevent hematoma.
Intervention :
Pain: the pain during the intervention will be almost non-existent, with an adapted anesthesia
Duration of the procedure: 45 minutes for the tensor threads, 60 to 90 minutes for the surgery
Anesthesia: local
Location: office for tightening threads, operating room for surgery
Outpatient (without hospitalization)
After surgery:
Post-operative pain: 1/10 often responding to Dafalgan
Social eviction:
Threads: 24-48h
Surgery: hematoma, marked swelling for 7 to 10 days, hypercorrection for 2 to 4 weeks, further marked swelling for 7 to 10 days.
Suture removal: 7 days for the surgery
Return to work: ideally 7 to 10 days of rest for the surgery, 1 – 2 days for the tensor sutures
Return to sport: 10 days after for the sutures, 2-3 weeks for the surgery
Instructions :
Rest in bed without major effort (which can cause the opening of small vessels during effort and lead to a hematoma) for 48 hours
Ice mask for 1 week, as often as possible, to reduce swelling
Take Arnica capsules 5 times a day for 5 days after surgery to prevent hematoma
Threads:
Control Dr Lucas D7, 3 weeks, 3 months
Disinfection with spray twice a day for 3 days at the entry point of the threads
Preventive antibiotic Augmentin 1 g twice a day for 3 days after surgery
Headband for 3 days during the night to protect the threads
Surgery:
Dr. Lucas control D2, D5, D8, 3 weeks, 3 months, 1 year
Vitamin A and artificial tears in the eye for 10 days
Scar massage 2 times 5 minutes per day for 3 months with Gorgonium as soon as the threads are removed
Do not touch the tapping for 10 days, these tappings will be changed at the time of the control consultations by Dr Lucas
Do not press on the lateral corner of the eye for 3 weeks.
Sun protection higher than 50 on the scar for 6 months after surgery if scar lateral to the eyes
Complications
-Secondary displacement of the thread: if the thread is stimulated too strongly during the 7 days following the procedure, it may come off. This happens most often with absorbable tensor sutures, but can also happen with a suture placed during surgery.
Nerve or vessel damage: the major risk is to damage the temporal branch of the facial nerve, which controls the elevation of the eyebrows, during the placement of threads or surgery. The placement of tensor threads in the context of a “Cat Eyes” must be performed by a doctor who is familiar with the anatomy, with which the risk of nerve damage is almost non-existent.
-Hematoma: there can be bruises, which generally disappear within 4 to 5 days maximum.
-Asymmetry: the canthal balance is precise, symmetrizing it is the work of a goldsmith, discreet asymmetries are often already present before the operation without the patient realizing it.
– Change of the eye’s expression: it is important to be aware that the canthal balance is a key element of the exe’s expression and of the overall expression of the face. If it is too strongly positive, it may change your face abruptly and you may have difficulty getting used to it. You should therefore aim for a discreetly positive canthal tilt and not a significantly positive one.
– Folds on the skin: this sometimes happens when the eyebrow has to be significantly raised or when there is a lack of flexibility in the tissues. These folds will disappear in 7 days on average.
– Infection: often treated with antibiotics and local care. Exceptionally, the sutures must be removed when the infection is not controlled despite the preceding measures.
Alternatives and operations that can be combined:
Global rejuvenation of the eye: this operation can be combined with a blepharoplasty, a brow lift or a filling of hollow temples.
