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Year Book 1992
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Camirand A, Doucet J
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Montreal (Québec)
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Oper Tech Plast Reconstr Surg l :160-171, 1994 1 34-96-4-46
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Introduction
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Clasically, the aging eye has been treated by removing skin from the lids and excising fat pads. Recent pathophysiologic observations have shown that, with advancing age, the eyeball drops and moves backward. An operative technique based on reinforcing the orbital septum via a transconjunctival approach is safe and relatively straightforward and produces natural-appearing results.
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A Physiologic Approach
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The lateral canthus attaches to the capsulopalpebral fascia, the forward projection of the inferior rectus muscle sheet that becomes the lockwood suspensory ligament, an inelastic structure. If the lateral attachment stretches, the eyeball is lowered, limiting the space between the eye and the orbital floor and displacing orbital fat forward. By performing a lateral canthopexy with thorough detachment of bone, orbicularis muscle, and skin and completely freeing the orbital septum, the lateral canthus may be elevated by as much as 7 mm. Incising excessive scar tissue will promote upward excursion of the margin of the lower lid. It is easiest to reinforce the orbital septum via a transconjunctival approach.
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Results
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Swelling usually begins to resolve within 1-2 weeks of surgery.
* I don't know why this does not cause restriction of upward gaze, but it doesn't seem to. Also, the concept of replacing the fat in some individuals rather than skeletonizing the orbit is important. Dr. Camirand has advanced Dr. De La Plaza's concept (1 ) by showing how it could be done through the conjunctival approach. In addition, with support of the lateral ligaments, one can actually reduce some wrinkling without any resection.
R. McKinney, M.D.
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Reference
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- De La Plaza R, Arroya JM: A new technique for treatment of palpebral bags. Plast Reconstr Surg 81:677, 1988
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