Selection of canthopexy techniques

Abstract

Dr. Carraway: The types of canthoplasty and canthopexy that we will be considering are tarsal strip procedure, lateral canthal tightening, transposition of the lateral canthal tendon, the dermal-orbicular pennant canthoplasty, and the inferior lateral retinacular canthopexy. Dr. Patipa, what is your indication for use of lateral canthal tightening? James H. Carraway, MD Dr. Patipa When I examine a patient's lower eyelid and midface, looking for laxity of the lateral canthal tendon, I primarily assess mobility of the lateral canthal angle. I will then tighten the lateral canthal tendon as part of the surgical procedure to achieve the desired result. Boaz J. Lissauer, MD Dr. Carraway: Dr. Lissauer, how would you use the tarsal strip procedure? What kind of patients would be appropriate? Dr. Lissauer: I use lateral tarsal strip procedures in patients in whom there is significant lengthening of the tarsoligamentous sling with horizontal lid laxity that clinically presents as frank eyelid malposition or cosmetically presents as a rounding or bowing of the temporal aspect of the lower eyelids. Michael P. Grant, MD, PhD Dr. Carraway: Let us now discuss the dermal-orbicular pennant canthoplasty as described by Marsh Edgerton.1 Dr. Grant, do you use this procedure and, if so, under what circumstances? Dr. Grant: This procedure falls in between lateral canthal tightening procedures, as Dr. Patipa described, and a frank lateral tarsal strip. I would use this procedure where there is laxity at the lateral canthal angle and, perhaps, some lateral lid retraction, but not frank horizontal lid laxity with the more pronounced potential for displacement at the lateral canthal angle. Thus I see this as a compromise procedure, similar to other types of suture suspension procedures, but less aggressive than a lateral canthal tightening procedure. Michael Patipa, MD Dr. Patipa: I would like to clarify that in the …