The purpose of this study was to prospectively analyse 50 patients submitted to lower blepharoplasty, using a skin muscle flap and routine canthal support with lateral canthopexy at the Federal University of São Paulo, between April 2005 and May 2007.
Methods: Fifty patients were assigned to interventions. All patients were treated with lateral canthal support (canthopexy).
Results: The median follow-up was 395 days (range 364–547 days). The mean age was 48.8 years, the population’s gender was predominantly female (96%). Lateral canthal support was performed in all patients with statistically significant results.
Conclusions: Lateral canthal support should be considered a routine component of lower transcutaneous blepharoplasty.
Historically, the most common complication following lower-lid blepharoplasty is lower eyelid malposition, with published complication rates ranging from 5–30%1–4. Causes include excessive skin, fat or muscle removal, scar contracture, intramuscular haematoma, orbicularis oculi muscle paralysis, adhesions in the middle lamella, uncorrected lower-lid laxity, and proptosis. The most prevalent aetiological factor in post-blepharoplasty lid malposition is vertical deficiency of the anterior or posterior lamella in the setting of tarsoligamentous laxity1–5. To avoid the typical deformity seen after a lower-lid blepharoplasty procedure, canthopexy (canthal tightening without cantholysis) and canthoplasty (canthal reattachment after cantholysis) have been adopted into cosmetic surgery for the correction (or prophylaxis) of lower‑lid malposition, and to optimise vertical eyelid position by tightening or shortening the lower eyelid horizontally1,3–8.
Canthoplasty and canthopexy is the tightening of the outer corner of the eyelid. Although the terms are sometimes used interchangeably, canthoplasty and canthopexy are different surgical procedures. Canthoplasty involves cutting through the orbicularis oculi muscle, detaching the lateral canthal tendon from the bone at the side of the eye socket, and removing a piece of the tendon. The internal structure of the lower-lid is then pulled over and attached to the spot on the eye socket where the tendon had been attached. Canthopexy, however, uses sutures to tighten and stabilise the same tendon and muscle without detaching or reconstructing the tendon. In general, all methods of canthopexy and canthoplasty correct tarsoligamentous laxity, thereby counteracting the downward forces of healing1,3–8. Treatment can include simple massage exercises as advocated by Carraway9, lateral canthal repositioning, vertical skin recruitment, and spacer grafts1,3–10.
The purpose of this study was to review the experience of the author with 50 patients submitted for transcutaneous lower eyelid blepharoplasty using a skin muscle flap and routine canthal support with lateral canthopexy.
Lower eyelid displacement with anterior traction (distraction test) can precisely determine the degree of laxity and guide lower eyelid canthal repositioning; anterior distraction greater than 6 mm from the globe indicates significant lid laxity, which may require lateral canthal repositioning.
The anatomical relationship of the orbital region should also be evaluated secondary to the direct effect of lower blepharoplasty. The posterior displacement of the orbital rim in relation to the anterior cornea and lower-lid margin, known as a negative vector, should be appreciated preoperatively. Prominent or deep-set eyes should be documented. A more detailed analysis can be performed using exophthalmometry with a Hertel or Lued exophthalmometer, which measures the position of the globe relative to the lateral orbital rim (normal range 16–18 mm)11,12.