The Eyelid Owner's Manual

Photo Essay

Caution: Actual surgery photos

Lateral Canthopexy with Lower Eyelid Skin Excision
Photographed from Start to Finish

For an in-depth discussion on canthopexy, refer to the video
Canthopexy: Because the Lid is More Than Skin and Fat

Note: Canthopexy may be performed using a variety of different surgical approaches. The version shown here is a modified lateral retinacular suspension intended to both stabilize canthal support and reinforce stretched orbicularis muscle.

Surgery performed by Dr. Frank Meronk

(Patient has already undergone upper eyelid blepharoplasty. The outer end
of the upper incision has been left open for access during 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.
Before	Immediately after
Note full retention of the eyelids' sharp 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. More information: Canthopexy: Because the Lid is More Than Skin and Fat (Video) Canthopexy: Pros and Cons (QuickNote) Before-and-after photos of other patients with canthopexy