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There are numerous types of eye reshaping of which the most commonly known and performed are rejuvenative in nature. Traditional blepharoplasties and browlift procedures are typically done in older patients and treat age-related periorbital changes of which the goal is to refresh one’s appearance and not really change it. Less commonly known and usually performed on younger patients is true eye reshaping whose intent it to change one’s appearance. Asian double eyelid surgery is the most widely performed in this type of eye reshaping but Cat Eye and Hunter Eye surgery can also be done but are not as well known.

Cat eye surgery is female eye reshaping with the intent of creating a wide eye appearance with a distinct upward tilt to the outer eye corner and the tail of the eyebrow. This may give the eyes a bigger appearance but their exaggerated shape also adds an expressive appeal. While this may seem to be a more recent trend amongst young women it is actually not a completely new style. One needs only to view the 1948 film, The Red Shoes, where the major female actress in the movie displays this exaggerated eye appearance…albeit for theatrical purposes.

The fundamental components of the Cat Eye procedure is raising the outer eye corner and a temporal browlift which are variations of well recognized eyelid and eyebrow procedures. But the one important difference in this type of eye reshaping from that of eyelid/euebrow rejuvenation is that in the younger female there is no age-related tissue laxities or looseness. Raising up naturally taut tissues from their natural  position requires aggressive techniques to not only achieve the effect but to have any chance to maintain even some of the effect. It is not an effect that can be achieved by any minimally invasive surgery. It requires a three incisional level technique, at the eye corner, at the upper eyelid and one in the temporal hairline.

Getting the outer order of the eye lifted, both effectively and to be maintained, requires a lateral canthoplasty, specifically a double hole technique. While a small incision is needed at the eye corner for release of the tissues from the bone, making the double drill holes requires a lateral upper eyelid incision. This small upper eyelid incision is right over the tail of the brow bone. It ensures that the double holes will be placed above the frontozygomatic suture line. A permanent suture is used which lifts the eye corner as high as possible. There is no fear that it will stay too high so it should look ‘overdone’ when the suture is tightened down. There is always going to be some eventual partial relapse so the higher the better.

Through the upper eyelid incision a good release can be done of the tightly adherent eyebrow tissues to the bone for the temporal browlift. Wide subperiosteal release can be done up onto the bony forehead and across the bony temporal line unto the deep temporal fascia. Through an additional small scalp incision behind the temporal hairline, the dissection from below is connected. It is important to do the tissue release behind the scalp incision in a wide fashion as well to support what is really an epicranial tissue shift to create the temporal browlift. Like in any endoscopic browlift (and the endoscope is not needed in this type of browlift) the lifted brow tissues is fixed by either a bone fixation method or suturing to the deep temporal fascia depending upon the scalp incision location. To support the temporal browlifts I prefer to apply cross forehead taping for a few days as a well as a circumferential head wrap for the first night after surgery.

I advise patients that immediately after surgery their appearance will look extreme. It all may look too high and over done but give it a few weeks and the result will look less exaggerated and settle to an uplifted but not over done look. In Cat Eye surgery the potential adverse long term issue is whether enough of a result has been achieved despite how it may immediately look after surgery.   

Dr. Barry Eppley

Indianapolis, Indiana 

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