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Year Book 1992
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André Camirand, MD
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Montreal (Québec)
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Can J Plast Surg 1:184-187, 1994
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1 34-95-4-45
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Background
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The lateral canthus stretches with age, lowering the lateral corner of the eye from 2-3 mm above the medial canthus in youth to the level of or below the medial corner in old age. The lower lid drops from 2 mm above the lower limbus to below it, creating pseudodermachalasis. This condition cannot be improved by lower blepharoplasty. Canthopexy and transconjunctival Blepharoplasty are suggested alternatives.
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Technique
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A line drawn from the middle of Cupid's bow to the lateral ala of the nose toward the tail of the brow serves as the traction line on the canthus. This line can be used to map the direction and localization of the skin incision. The incision can be made anywhere between this line and the level of the lateral canthus. The surgeon identifies the vertical fibers of the orbicularis muscle after making the incision. Using small, blunt dissecting scissors, the surgeon frees the fibers from the skin and underlying tissues. The vertical fibers are cut with electrocautery and the edges cauterized to make them more inefficient. The lateral canthus, although not visible, can be easily felt. The surgeon detaches it from the orbital rim by gripping it with forceps and cutting it with a small scissors. The canthus is freed from the orbital ridge to the level of the iris with scissors or freer It must also be freed from the orbicularis and skin attachments until it can be easily, freely mobilized. The attaching bands, which can be easily felt, must be severed. The freely mobile canthus is pulled in the previously marked direction. With the patient looking forward, the lower limbus is covered by 2 mm of the lid margin. Reattachment must be 5-7 mm above the original insertion, 5 mm above the frontozygomatic fissure, or opposite the upper level of the pupil. Using 4-0 Polydek with an ME2 needle, the canthus is sutured to the periosteum inside the orbit. The orbicularis is not sutured. The skin is then closed.
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Conclusion
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With canthopexy, the lateral canthus is raised by 5-7 mm. As the canthus is sutured in its new position, the skin of the lid is redraped, eliminating the pseudodermachalasis and horizontal wrinkles and producing an almond-shaped eye. A transconjunctival approach should be used to remove fat pads.
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> The lash incision always produces a favorable scar. This approach avoids that problem and results in less of a malpositioning of the lower lid than seen with conjunctival Blapharoplasty.-P. McKinney. M.D.
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