Fixing Eyelid Asymmetry with Medial Canthal Tendon Surgery

Introduction

In aesthetic surgery, the eyes are often described as the most expressive feature of the face. They convey our emotions, reflect our energy, and form the foundation of facial harmony. Yet, when there is noticeable asymmetry — especially near the inner corners (the canthus) — even subtle differences can make the eyes appear uneven, tired, or unnatural. One of the less-discussed but essential surgical techniques for correcting this imbalance is medial canthal tendon surgery.

At Gangnam Seoyon Plastic Surgery, we often meet patients who come in after primary eyelid surgery elsewhere, still feeling that something looks “off” when they look in the mirror. Sometimes it’s not just about eyelid height or crease shape — the true issue lies deeper, in the structure that anchors the inner corner of the eye: the medial canthal tendon.

Understanding the Medial Canthal Tendon

The medial canthal tendon (MCT) is a small but crucial fibrous structure located at the inner corner of the eyelid. It attaches the eyelids to the bony rim of the eye socket and ensures that both the upper and lower lids align properly against the eyeball. When this tendon is too tight, loose, or uneven between the two eyes, it can cause visible asymmetry — one eye may look rounder or more open, while the other appears narrow or slanted.

This imbalance can be congenital (present from birth), age-related, or the result of previous eyelid surgery, trauma, or scar contraction. In revision eyelid cases, for example, the MCT can become distorted by excess skin removal, over-tightening, or improper anchoring during medial epicanthoplasty (inner corner reshaping).

When Eyelid Asymmetry Is More Than Skin Deep

To be honest, most patients don’t realize that inner-corner asymmetry isn’t just about skin or fold lines. They come in thinking their ‘crease’ is uneven, but during close examination, we find that the tendon itself sits at a slightly different position or tension on each side. This deeper imbalance can distort the natural curvature of the eyelid, leading to issues such as:

• One eye appearing closer together or more “pinched”

• Asymmetrical eye length or shape

• Visible difference in tear duct exposure

• A sense of imbalance even after previous surgeries

When this is the root cause, simply revising the skin or crease won’t fix the problem — the foundation itself must be corrected. That’s where medial canthal tendon surgery becomes essential.

What Is Medial Canthal Tendon Surgery?

Medial canthal tendon surgery focuses on adjusting or repositioning the tendon that defines the inner corner of the eye. Depending on the problem, it can involve tightening, releasing, or reattaching the tendon to achieve better symmetry and contour.

In some cases, the surgeon may perform a canthopexy (tightening procedure) to correct laxity. In others, a canthoplasty (structural repositioning) is needed to change the actual insertion point of the tendon. The approach is highly individualized — even a 1–2 mm difference can dramatically change the expression and balance of the eyes.

At Gangnam Seoyon, Chief Director Dr. Dong-il Choi performs this procedure with precision gained from over 20 years of eyelid and revision experience. Using micro-surgical methods and magnification, the tendon is carefully released and adjusted in a way that restores the eye’s natural proportions while minimizing trauma and scarring.

Why This Procedure Requires Expertise

To the untrained eye, medial canthal tendon surgery may sound like a minor adjustment. But in truth, it demands the same level of precision as a delicate restoration. The tendon is surrounded by important structures — including the lacrimal (tear) system, orbital fat, and fine blood vessels — so the surgeon must have deep anatomical understanding and surgical control.

If performed too aggressively, it can lead to complications such as:

• Overcorrection, where the inner corner appears too sharp or pulled

• Under-correction, where asymmetry persists

• Damage to the tear duct, causing chronic tearing

• Scarring or unnatural contours

That’s why this type of surgery should only be handled by a specialist familiar with complex eyelid anatomy and revision cases. At Seoyon, we always prioritize minimal dissection and precise fixation — maintaining both aesthetic harmony and functional safety.

The Emotional Aspect of Eyelid Asymmetry

Eyelid asymmetry isn’t merely a cosmetic concern; it can affect a person’s self-image deeply. Many patients describe feeling that their face looks “unbalanced” or that their expression doesn’t match how they feel inside. For those who have undergone prior surgery, this can be especially frustrating.

To be honest, revision patients often carry emotional scars along with physical ones. They may have lost trust in the surgical process. That’s why, at Gangnam Seoyon, every consultation begins with a detailed analysis and a transparent explanation of what is realistically achievable. Sometimes, we even recommend waiting for tissue stabilization before proceeding — because timing can be as important as technique.

Combining Artistry and Anatomy

In aesthetics, symmetry doesn’t mean perfect duplication — it means natural harmony. The goal of medial canthal tendon correction isn’t to make both eyes look identical, but to restore balance so that the gaze appears bright, soft, and alive.

Dr. Choi often describes this as “refining the rhythm of the eyes” — much like tuning an instrument. When done correctly, the improvement is subtle yet transformative: the eyes appear more open, proportionate, and emotionally aligned with the rest of the face.

Healing and Aftercare

Recovery after medial canthal tendon surgery varies by individual, but most patients can expect:

• Mild swelling and bruising for 1–2 weeks

• Stitches removed around day 5–7

• Natural results emerging over 1–2 months as tissues settle

As with all delicate eyelid work, aftercare is key. Patients are advised to avoid rubbing the area, use prescribed eye drops or ointments, and attend all follow-ups to ensure proper tendon healing. Because the surgery involves deep fixation, full stabilization can continue over several months — and patience during this period is essential.

When to Consider a Second Opinion

If you’ve had eyelid surgery and still notice asymmetry around the inner corners, or if your eyes feel tight or uneven when you smile, it may be worth seeking a second opinion. A detailed evaluation using magnified photography and structural assessment can reveal whether the medial canthal tendon is involved.

At Gangnam Seoyon Plastic Surgery, our priority is always to identify the true source of asymmetry before recommending any surgical plan. Sometimes, that means combining tendon adjustment with subtle skin revision or crease correction; other times, it means conservative observation.

Restoring Balance, Inside and Out

Fixing eyelid asymmetry through medial canthal tendon surgery isn’t just about appearance — it’s about restoring balance, comfort, and confidence. When the anatomy of the eye is properly aligned, the face regains its natural symmetry, and the person behind it often rediscovers something equally important: peace of mind.

If you’re uncertain whether tendon correction could help in your case, consider scheduling a personalized consultation with a safety-focused clinic like Gangnam Seoyon Plastic Surgery in Seoul. Under the care of Dr. Dong-il Choi and our experienced team, we approach every eyelid with respect, precision, and an unwavering commitment to natural beauty.