The Role of Canthoplasty in Aesthetic Blepharoplasty

Abstract

Dr. Carraway: The first case is a 37-year-old woman who has had no previous surgery and desires correction of bilateral scleral show and ptosis (Figure 1). However, if we correct her prosis, it will increase the amount of scleral show. If we correct her lower lid scleral show and don't correct her ptosis, she will have a narrow fissure and an aesthetically unacceptable result. Dr. Patipa, what do you think about this particular problem? Figure 1 A 37-year-old woman with bilateral eyelid ptosis and bilateral scleral show. Dr. Patipa: I believe this patient's appearance is similar to a patient with thyroid ophthalmopathy because she has the acquired ptosis and lower lid retraction. In my preoperative evaluation, I would perform a Neo-Synephrine® test, and, if she has satisfactory elevation of the upper lid, I would address her ptosis with a mullerectomy of probably 7.5 or 8 mm rather than repairing or advancing her levator. This would give a more predictable result with less risk of overcorrection for her mild acquired ptosis. Evaluating her lower lids clinically, I don't believe her problem is isolated to her eyelids. I believe she has midface descent that is contributing to her scleral show and her lid retraction. My surgical approach would be to reattach or tighten her lateral canthal tendons. I would perform a limited subperiosteal midface suspension (as with a thyroid patient) to give her optimal results. She probably needs some type of spacer (I would use a hard palate graft as a spacer) because the midface lift and lateral canthus lift will not elevate the center of the eyelid up to the inferior cornea. James H. Carraway, MD Norman Shorr, MD Gordon Sasaki, MD Michael Patipa, MD Dr. Sasaki: I would like to bring up some other points. This patient has upper eyelid ptosis …