(Patient shown here has first undergone upper eyelid blepharoplasty. The outer end of the upper lid incision has been left open for access during the canthopexy.)
1. A lower skin incision is made just below the eyelashes across the outer two-thirds of the lid.
2. Through the upper incision, the edge of the rim of orbital bone is exposed.
3. A skin-only flap is dissected on the lower lid. The underlying orbicularis muscle is left entirely intact to avoid scarring and interruption of nerve supply.
4. Another view of the skin flap from a different angle. At this point, the lid appears to have a large amount of extra skin.
5. Suture is placed through the orbicularis muscle and then passes upward through the lateral retinaculum, including the canthal tendon.
6. Note the firm support provided by pulling up on the sutures.
7. The sutures are passed through the lining of the bone just next to the eye (orbital rim).
8. Once tension has been adjusted, the sutures are tied to one another and the knot is cut short.
9. After the upper incision has been closed, the excess skin is measured and marked. Note how this amount is only about half of what seemed to be present in photos 3 and 4 before performing the canthopexy.
10. Excess skin has been removed. The orbicularis muscle had been fully preserved.
11. The lower eyelid skin incision is closed.
Note full retention of the eyelids' sharp but lifted angle and strong support. Skin tension lines disappear over the first week. No fat was removed.
Canthopexy is often performed along with other procedures (most commonly, transconjunctival fat trimming and chemical peel) as part of a more comprehensive lower eyelid rejuvenation. If no skin is to be removed, the external incision is much smaller.