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BLEPHAROPLASTY 101
The Essential Patient Reference

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Topic 19 - 1
Canthopexy
and Canthoplasty
tissue-sparing lower eyelid surgery   canthopexy pros and cons

LATERAL CANTHUS

19: Canthopexy and canthoplasty
- Canthopexy and canthoplasty
- Canthopexy pros and cons
- Cosmetic canthoplasty
- Canthopexy surgery photos
- Canthoplasty surgery photos


TERMINOLOGY

While the terms canthoplasty and canthopexy are sometimes used interchangeably, the two procedures are very different.

"Canthoplasty" refers to an operation designed to reinforce lower eyelid support by detaching the lateral canthal tendon from the orbital bone and constructing a replacement.

"Canthopexy," on the other hand, refers to a less invasive procedure designed to stabilize or reinforce the existing tendon (as well as surrounding structures) by surgical suturing without removing it from its normal attachment.

While their names may sound very similar, canthopexy and canthoplasty are often confused, as explained in the following two videos.


EVEN MORE NAMES

As if the above were not already confusing, other terms used to denote the same or similar operations include tarsal strip resuspension, lateral canthal plication, tarsal sling, lateral retinacular suspension, inferior retinacular suspension, and more.

Canthopexy

 

Canthopexy and Canthoplasty:
What's the Difference?

PRIMARY GOAL

Strengthening the tissues at the outer corner of the eyelids (lateral canthus) to better support the lower eyelid.


SECONDARY GOALS

Lessening the chance of surgical complications most commonly associated with transcutaneous (skin incision) lower blepharoplasty.


ANESTHESIA

Local injection


OPERATIVE TECHNIQUE

(Note: If the anatomical terms that follow seem confusing, refer to these anatomical illustrations).

Tarsal strip resuspension (a version of canthoplasty) is described:

Scissors are placed at the junction of the outer upper and lower eyelids (the lateral commissure) and a full-thickness cut is made into the lateral canthus towards the orbital bony rim. The lower half of the lateral canthal tendon extending from the bony rim into the lower eyelid is isolated and cut free from its attachment to the bone. An incision is made on the eyelid margin a small distance (approximately 1/5 inch) from the cut tendon, and the tarsal plate closest the tendon is cleaned of all adherent skin and conjunctiva. This creates a small strip of tarsal plate tissue, a cartilage-like structure that will be used to create "a new and tighter tendon." A non-absorbable suture is used to sew this strip of tarsal plate to the periosteum (the lining of the bone) located just inside the socket's bony rim. The attachment is reinforced with dissolving sutures, and the overlying muscle and skin are closed.


VARIATIONS

There are MANY variations in surgical technique, which allows for the level of reinforcement to range from minimal to marked. For instance, rather than tightening the lateral canthal tendon, it is possible to remove a full-thickness "chunk" of lower eyelid and sew the raw edges together ("full thickness horizontal resection"). While this simplified approach may help the lower eyelid to grip the eye, it is inferior to a tarsal strip resuspension because (1) it does not "reconstruct" a new tendon, and (2) it is quite risky in individuals with prominent eyes or poor orbital rim/cheek bone support in that it may cause the eyelid to retract downward.

Less invasive variations on canthal tendon tightening (canthopexy) involve "tucking" the soft tissues just below the end of the tarsal plate by sewing them to the lining of the orbital bone. While different approaches to canthopexy vary from simple to complex, we prefer our own modification developed over years of experience. While some surgeons use canthopexy on almost every case, we apply it selectively in less than a third of our patients.

The "key" step in all of these closely related operations is the attachment of either supporting tendon, muscle, and/or tarsal plate to the tough periosteum (external lining) of nearby bone.


ADVANTAGES

If the lateral canthal tendon, surrounding supporting structures (retinaculum), and/or orbicularis muscle are stretched, canthal tendon reinforcement helps to restore more normal support to the lower eyelid. Canthopexy is not, however, indicated as a "routine" measure in all lower blepharoplasties.


CARE AND RECOVERY

As noted in Section Four. In addition, swelling in the upper and lower eyelids as well as the eye (chemosis) may persist for several weeks to months due to temporary interruption of the lid's lymphatic drainage.


RISKS AND COMPLICATIONS

Canthoplasty: The anatomy of the canthus is delicate and complicated. If canthoplasty is not well performed . . .

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