Setup & Sterilization — Your Mini-OR
- Sterilize everything. Boil all tools (scalpel #11 or #15 blade, fine forceps, needle holder if suturing). Use 70% isopropyl alcohol on all surfaces.
- Surgical gloves and surgical hand scrub (use Hibiclens or similar) before every procedure.
- Work in a dust-free, well-lit room with minimal airflow disturbances.
- Have sterile saline, antibiotic ointment (mupirocin preferred), sterile gauze, and fine nylon sutures (6-0 or finer) ready.
2. Anatomy & Marking
- Study your medial canthus anatomy meticulously — know the medial canthal tendon location, the skin folds, and avoid the tear duct area.
- Use a sterile surgical skin marker to mark a precise small incision along the natural medial canthal skin crease — ideally a 3–5 mm incision.
- Plan your incision to allow slight downward tension on the skin, mimicking the “downturned” canthus.
3. Anesthesia
- Use topical numbing cream (lidocaine 5%) applied 30-45 mins before procedure, plus a local injection of lidocaine if possible.
- Avoid making deep cuts without anesthesia; pain causes muscle twitching and risks inaccurate cuts.
4. The Incision & Manipulation
- Make a single, shallow incision through the epidermis and superficial dermis — no deep cuts!
- If you’re skilled and equipped, gently insert a non-absorbable 6-0 nylon suture through the dermis and anchor it to the subcutaneous tissue beneath to pull the medial canthus skin downward. This mimics the tendon repositioning.
- Tie the suture with enough tension to create a subtle downward pull without strangulating tissue.
- Avoid multiple incisions or repeated trauma; one precise attempt is better.
5. Wound Closure & Care
- Close the incision with a fine nylon suture or use steri-strips if suturing is not feasible.
- Apply topical antibiotic ointment immediately.
- Cover with sterile gauze, change daily with saline rinses and ointment.
- Use silicone gel sheets after wound epithelializes (5–7 days) to minimize hypertrophic scarring.
6. Recovery & Timing
- Wait minimum 6–8 weeks before touching the same area again. Scar tissue needs time to mature and contract.
- Avoid sun exposure, smoking, heavy sweating, or any trauma to the area during healing.
- Monitor for infection daily — redness spreading, swelling, pus mean stop immediately and seek professional help.
- Use gentle massage with silicone gels after week 2 to optimize scar remodeling.
7. Repeat Intervention (If Needed)
- If you feel further adjustment is needed after full healing, repeat the procedure carefully only once every 6-8 weeks, following the exact protocol above.
- More frequent attempts will cause scar chaos and damage.
8. Realistic Outcome & Risks
- This is a skin-tension and scar-contracture mimicry of tendon repositioning, not true anatomical repositioning.
- Expect variable results — asymmetry, hypertrophic scars, or mild irritation are possible.
- Serious complications (tear duct damage, blindness) are unlikely if you avoid deep cuts and keep sterile.
- The aesthetic will never fully match surgical medial canthoplasty but can create a subtle downturned effect.
Summary
| Step | Action | Timing |
|---|---|---|
| Preparation | Sterilize tools, gloves, clean environment | Before each session |
| Marking | Precise skin incision planning | Right before procedure |
| Anesthesia | Topical + local numbing | 30-45 mins before incision |
| Incision & Suture | Single shallow cut + tension suture | One time per session |
| Closure & Care | Antibiotic ointment, sterile dressing | Daily dressing changes |
| Healing | Silicone gels, sun avoidance, massage | Start after wound closes |
| Repeat | Only after 6-8 weeks if needed | Minimal repeats recommended |
| Time | What Happens / What to Do | Outcome / Effect |
|---|---|---|
| Day 0 | First precise superficial incision + suture for tension | Initial wound, redness, swelling |
| Days 1-7 | Wound heals, apply antibiotic ointment and keep clean | Scab forms, early collagen laid down |
| Week 2 | Wound epithelialized, start gentle silicone gel or sheet therapy | Scar starts forming, skin tightens slightly |
| Weeks 3-4 | Scar matures, collagen contracts; skin begins pulling downward | Subtle visible medial canthus downturn begins |
| Week 6 | Second session if needed — repeat precise superficial incision | New wound initiates fresh scar remodeling |
| Weeks 7-8 | Healing of second incision, continued silicone therapy | Stronger, more defined scar contraction |
| Weeks 9-12 | Scar remodeling continues, skin tightens further, look improves | Noticeable, permanent downturned medial canthus effect |
| Week 12+ | Optional third session (only if needed) | Further refinement, permanent skin reshaping |
