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Background: Facial paralysis is a life‐altering condition that may arise from various etiologies, ranging from trauma to malignancy. Permanent facial paralysis may occur secondary to facial nerve sacrifice or irreversible damage to the nerve. In these particularly devastating cases, protection and maintaining function of the eye is paramount. There are many effective lagophthalmos corrective surgical procedures available for these patients. While placement of eyelid weights and lid tightening surgeries are the cornerstone of eyelid rehabilitation, limited information exists on whether the timing of eyelid interventions in the setting of permanent facial paralysis impact outcomes, including need for revision surgery. Methods: A single‐center retrospective chart review was performed for patients with irreversible facial paralysis treated with an upper eyelid weight between 2013 to 2022. Electronic health records were acquired to obtain facial paralysis etiology, associated clinical characteristics, the type of intervention, and the timing of intervention. Patients were classified as immediate if the eyelid weight operation occurred within 29 days of the initial facial paralysis and delayed if the surgery occurred 30 days or more after initial presentation. Outcomes were assessed in terms of revision procedures and surgical complications. Results: There were 70 patients in total, with 35 patients in the immediate category and 35 patients in the delayed category. The most common etiology related to parotid gland pathology, and 58.6% of patients had facial paralysis from cancer‐related surgeries. There were no significant differences in revision rates (p < 0.208) or in the types of procedures (p = 0.077) between the two groups. The complication rates also did not differ significantly between groups; however, there were only complications in the delayed intervention group. Conclusions: These findings suggest there is no difference in postoperative complications between groups, including the need for revision surgeries when comparing groups with immediate or delayed intervention. Thus, treatment plans should be customized based on patient and provider preferences. [ABSTRACT FROM AUTHOR]

Summary: Background: Blepharoplasty is a surgical procedure that modifies the shape and structure of the eyelids to restore a more youthful appearance. The procedure comprises the removal of extra muscle, fat, and skin. In order to get the optimum functional and aesthetic result, supporting components like canthal tendons can also be tightened. Aim: To evaluate the efficacy of canthopexy in conjunction with the upper and lower blepharoplasty technique and its complications. Methods: A total of 400 individuals who underwent these procedures between January 2020 and January 2021 had been recruited for this study. The frequency and clinical complications were analyzed. Results: The complications were found to be 17 (4 %) cases of relapse, 12 (3 %) temporary hematoma formation, 11 (3 %) cases of epiphora, 8 (2 %) cases of unequal eyelid positioning, 5 (1 %) patients developed conjunctivitis and chemosis. Conclusion: This method appears to be effective since it is simple, practicable, and capable of delivering positive functional and aesthetic effects with a minimum of side effects.

Blepharoplasty is a surgical procedure that modifies the shape and structure of the eyelids to restore a more youthful appearance. The procedure comprises the removal of extra muscle, fat, and skin. In order to get the optimum functional and aesthetic result, supporting components like canthal tendons can also be tightened. To evaluate the efficacy of canthopexy in conjunction with the upper and lower blepharoplasty technique and its complications. A total of 400 individuals who underwent these procedures between January 2020 and January 2021 had been recruited for this study. The frequency and clinical complications were analyzed. The complications were found to be 17 (4 %) cases of relapse, 12 (3 %) temporary hematoma formation, 11 (3 %) cases of epiphora, 8 (2 %) cases of unequal eyelid positioning, 5 (1 %) patients developed conjunctivitis and chemosis. This method appears to be effective since it is simple, practicable, and capable of delivering positive functional and aesthetic effects with a minimum of side effects. [ABSTRACT FROM AUTHOR]

In an effort to prevent post-operative eyelid complications, lower blepharoplasty requires taut approximation of the lower lid to the globe. This is routinely accomplished with lid tightening procedures and/or canthal fixation. Multiple techniques can be utilized in combination to appropriately and aesthetically reposition the lower eyelid during cosmetic blepharoplasty. These techniques include simple canthopexy, canthoplasty, drill hole fixation, and complete tarsoligamentous sling reconstruction. In this article, we examine the unique anatomy of the lateral canthus as well as the indications for utilizing diverse options for canthal fixation., Competing Interests: Disclosure Dr S J. Pacella is a principal investigator, lecturer, advisory board member and consultant for TelaBio, Inc.Dr S J. Pacella is a lecturer and research consultant for Kerecis, LLC.There is no conflict of interest with respect to the authorship of this article. No products from the above companies are utilized in eyelid surgery or mentioned in this article. No commercial support or funding was received for the creation of this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Lower eyelid blepharoplasty has historically been approached from one of only two techniques, either the anterior subciliary incision or from the posterior transconjunctival approach. Both have been used with subtractive techniques of skin and fat resection in most cases and both have had issues with post operative lower lid retraction with scleral show, albeit less with the posterior approach. Lateral acces recontouring does not transgress either the anterior or posterior functional muscles of the lower lid and avoids damaging the innervation of the lower lid orbicularis. Thus the technoque has resulted in a zero incidence of slceral show in this series beginning in 2007. When combined with muscle lifting and fat preservation as recontouring techniques, and canthal support when indicated, it also provides excellent blending of the lid cheek junction for effective rejuvenation., Competing Interests: Disclosure None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

The lower lid cheek junction is a complex region. Patients are concerned about contour deformities of the lower eyelid and the cheek, but the causes of these issues are found in the underlying anatomy. Age-related bony changes result in a recessed infraorbital rim and a recessed maxilla. Loss of cheek soft tissue contributes to the formation of a tear trough deformity. Configuration of the tear trough comes in 3 classes, each of which requires a different surgical treatment. Combined procedures on the lower lid and the cheek often result in the most significant improvement., Competing Interests: Disclosure There are no disclosures of any commercial or financial conflicts of interest for this paper. There are no funding sources for the author of this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Although many epicanthoplasty techniques have been proposed, prominent hypertrophic scarring in the medial canthal region remains a problem. The aim of this study was to develop a novel design that has a less prominent scar with minimal tension. Methods: A total of 489 patients underwent thunderbolt Z-epicanthoplasty from July 2015 to April 2019, with or without blepharoplasty. A triangular myocutaneous flap was lifted from the upper part of the epicanthal fold. The surrounding area was dissected to remove the rigid connective tissue between the orbicularis muscle and the skin, which creates skin tension. A Z-shaped flap toward the inferomedial canthal portion was added to create space for the triangular flap to be transposed to change the straight incision into a curved zigzag incision (final scar in the shape of a "thunderbolt"), making the scar irregular and less conspicuous. Results: Postoperatively, all patients were followed up for ≥ 12 months. Among the patients, epicanthus tarsalis (60.12%) and palpebralis (36.19%) were the commonest epicanthus types, followed by epicanthus supraciliaris (3.07%) and inversus (0.61%). The average preoperative intercanthal distance was 42.25 ± 1.66 mm. This distance decreased significantly to 37.14 ± 1.78 mm (average, 5.11 ± 0.21 mm; p = 0.036) at the 12-month postoperative follow-up. Mild cicatricial redness was observed in the medial canthal area in six patients (1.2%) during the early postoperative period. The redness diminished within 6 months postoperatively. All patients obtained natural and aesthetically pleasing results without prominent hypertrophic scarring or other complications in the medial canthal area. Conclusion: The thunderbolt Z-epicanthoplasty is safe and effective for treating medial epicanthal folds. It is potentially helpful in minimizing postoperative medial canthal scarring and can be applied to various types of epicanthal folds with long-lasting results. Level of Evidence IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Non-Surgical Aesthetic IV. [ABSTRACT FROM AUTHOR]

Purpose: Different techniques for lateral canthal suspension have been used in the management of various eyelid malpositions. We describe a simplified technique for lateral canthal suspension and review its outcome along with a review of existing variations.Methods: We conducted a retrospective chart review of 28 eyelids in 22 patients who underwent simplified lateral canthal suspension. Demographics, symptoms at presentation, and associated eyelid malposition were noted. We evaluated the palpebral fissure and margin-reflex distance 2 (MRD2) on the preoperative and final postoperative photographs by using MEEI FACE-gram software. We also reviewed existing literature on different surgical management options for comparison.Results: At three-month postoperative follow-up, presenting symptoms resolved in all cases. The average postoperative decease in palpebral fissure was 0.73 mm (P = 0.018) and the average decrease of the MRD2 was 1.02 mm (P = 0.0003). Recurrence occurred by three months in one eyelid (4%) with ectropion due to moderate eyelid laxity, and this case was managed with tarsal strip procedure. One patient (5%) who had bilateral surgery had asymmetric lower eyelid position and one patient (5%) had persistent edema of the operated eyelid for six months.Conclusion: This simplified canthal suspension is a simple and effective technique that tightens the lateral canthal tendon and improves the lower eyelid position. It can be used in various mild-to-moderate eyelid laxities and has favorable operative characteristics compared with many existing techniques. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: To describe the upper and lower blepharoplasty technique associated with canthopexy with double pre septal orbicularis muscle elevation with a single suture in order to evaluate the efficacy of the technique. Methods: This is a retrospective study in which the medical records of 5,882 patients who underwent this technique between January 1999 and July 2015 were evaluated. The frequency and main causes of clinical complications and surgical reoperation were analyzed. Results: The incidence of complications found was 12.7% (n=750), being 0.8% (n=47) due to persistent chemosis, 3% (n=176) due to poor lower eyelid positioning, 4.17% (n=245) due to mild eyelid retraction and 4.8% (n=282) because of mild to moderate chemosis. Conclusion: The technique appears to be effective as it is simple and practical, and capable of resulting in positive functional and aesthetic outcomes with low rates of complications.

Copyright of Revista Brasileira de Oftalmologia is the property of Sociedade Brasileira de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The normal bony insertion of the medial canthal tendon can be disrupted after trauma, as a result of ablative surgery or as a consequence of subperiosteal detachment during a craniofacial surgical procedure. Medial canthoplasty is required to avoid telecanthus following these events. Several surgical techniques have been described to reattach the tendon to the posterior lacrimal crest. The techniques of transnasal wiring had been used widely to reconstruct medial canthal tendon. However, some surgeons have preferred the use of ipsilateral techniques that include the nylon anchor suture, the stainless-steel screw and/or miniplates. Aim of the study: This study aims to present a technique for Canthopexy and Medial canthal ligament reconstitution secondary to posttraumatic medial canthal degloving injuries using mini-screws and/or microplates to obtain a consistent and definitive reinforcement of the Medial Canthal ligament and its continuity to the postero-superior surface of the medial orbital wall. Materials and methods: The present study enrolled 23 patients with posttraumatic medial telecanthus deformity that had been treated over a 3-year period from July 2016–June 2019. Clinical examination had been scheduled for all patients regarding evaluation of lacrimal system function, medial canthal position in addition to eyelid measurements. Visual impairment and movements of the eye were evaluated by ophthalmological consultation. Irrigation and probing were used for evaluation of the nasolacrimal system. MCT detachment can be determined by Bowstringing test through subcutaneous palpation of the MCT as one stretches the lid laterally.Eyelid evaluation comprised recording measurements of the inter-canthal distance (ICD), the interpupillary distance (IPD) and the palpebral fissure length (PFL). Telecanthus was assessed by recording the distance (in millimetres) measured between the facial midline and the medial canthus of the injured eye that will be compared to the corresponding values of the uninjured eye preoperatively and at all postoperative follow-up intervals. Radiographic assessment was evaluated by axial, coronal and sagittal C.T scans preoperatively and at 1, 3 and 6 months postoperatively. Results: Medial Canthopexy with mini-screws was performed in 15 patients while a Y-shaped micro plate was utilized in 8 patients. The postoperative medial canthal position had been reported to be satisfactory in all patients, showing a considerable improvement compared with the preoperative position. The patients were re-evaluated at 1,3 and 6 months postoperatively demonstrating absence of any evidence of recurrence and with an acceptable cosmetic result, as the medial canthal concavity had been successfully achieved. All patients were satisfied except one that was overcorrected and re-operated for re correction. Another one was under corrected and had undergone revision. However, at 6 weeks postoperatively, one patient had a wound dehiscence resulting in medial canthal detachment and required retreatment. In all patients (except for the one of wound dehiscence), the post-canthopexy Bow String test failed to cause loss of canthal re-attachment and reconstruction or even lateral displacement of the medial canthal tendon throughout all the follow-up intervals. Conclusions: Medial Canthopexy using mini-screws and/or microplates is a simple, easy and reliable technique for the surgical correction of posttraumatic Telecanthus secondary to MCT detachment as this technique promotes satisfactory post-surgical outcomes with resultant acceptable esthetic and functional results.

Background: Orbital hypertelorism (OHT) represents a congenital condition defined by lateralization of the bony orbit, unlike soft tissue telecanthus in which there is an increase in intercanthal distance without true bony lateralization. Existing literature remains very limited in its postoperative assessment of bony versus soft tissue relapse, which may both clinically present as telecanthus. We performed a critical appraisal of the literature to determine the postoperative incidence of bony versus soft tissue relapse following OHT repair. Methods: The PubMed, MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, and clinicaltrials.org were searched systematically for all English studies published in any time frame reporting relapse rates following primary OHT repair. The primary outcome was incidence of bony and soft tissue relapse defined as orbital lateralization and medial canthal drift, respectively. The secondary outcome measures include postoperative complications, predictors of postoperative complications, timing and type of surgery, and revision rates. Results: Eleven articles were included. A total of 84 (35.3%) patients experienced bony relapse while 43 (27.2%) patients experienced soft tissue relapse. Age at time of intervention (p < 0.92), severity at presentation (p < 0.90), and surgical technique (p < 0.09) were not found be significantly associated with relapse rate. Methods for long-term follow-up were not standardized, and there was no consistent measure to objectively assess telecanthus. Conclusions: There is no general consensus on predictive factors of long-term relapse following OHT repair in the form of box osteotomy or facial bipartition. These findings call for cross-sectional outcome standardization to better understand long-term outcomes across institutional, provider, and patient differences. [ABSTRACT FROM AUTHOR]

Summary Background Median and paramedian craniofacial clefts are associated with hypertelorism, anterior encephalocele, positional abnormalities of the maxilla, and nasal deformity. Cleft lip and palate, eyelid coloboma, and widow's peak are frequently present. Methods The authors collected data from 30 patients (mean age, 5.8 years; range, 4 months to 18 years) operated between 1986 and 2017 with median or paramedian craniofacial clefts of differing degrees of severity. Malformations of the different anatomic units and their surgical treatment were assessed, as well as complication rates. Results All patients presented nasal malformations and either telecanthus (n = 16) or hypertelorism (n = 14). Most patients (n = 23) had anterior encephalocele. All patients underwent nasal corrections, and most of them had medial canthopexy (n = 24). Excision of encephalocele was associated with fronto-orbital remodeling. Medialization of the orbits was performed in 11 patients, mainly by box shift (n = 9). Patients from outside Switzerland (n = 23) were operated at an older age than those in the native patient group. Because of staged reconstruction, 13 patients had more than one operation. Surgical complications included three infections and one expander exposition. One patient had bone resorption of a frontal bone flap. Nasal correction needed more than one procedure in 5 patients, and medial canthopexy had to be repeated in 7 patients. Esthetic results were satisfactory, permitting social integration. Conclusion Median and paramedian craniofacial clefts need adapted and carefully planned corrections respecting the growth of anatomic units. The quality of the medial canthal and nasal reconstruction is to a large extent responsible for the overall result. [ABSTRACT FROM AUTHOR]

Background: Lower eyelid malposition is a known complication of lower (lid) blepharoplasty surgery. The prevention of this complication is easier than its treatment. Over the past 10 years lot of patients have had lower blepharoplasties with a canthopexy procedure and in some cases a tarsal strip canthoplasty. The criterion for a lateral tarsal strip canthoplasty was a lid distraction distance greater than or equal to 10 mm. Lid distraction distance is the distance the eyelid can be pulled away from the globe after the initial skin incision has been made and measured with calipers. If the eyelid can be pulled away from the globe less than 10 mm, then a canthopexy is performed, which occurred in 98% of cases. Patients had lateral canthopexies regardless of age or preoperative assessment. Herein, we describe a simple method of canthopexy that can be performed on most patients having a lower blepharoplasty, to not only achieve a cosmetically superior result but also to prevent eyelid malposition or ectropion. Conclusion: We have described a simple prophylactic canthopexy suturing technique that all surgeons performing lower blepharoplasty can do to prevent rounding or ectropion. Naturally, the more cases that are done, the more accurate will be the eyelid position and adequacy of eyelid tension achieved. Lateral tarsal strip canthoplasty is also used in more advanced cases of lid laxity. [ABSTRACT FROM AUTHOR]

Copyright of Journal für Ästhetische Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Thick skin presents a unique set of challenges within the realm of facial plastic surgery, and addressing the lower lid complex is no exception. There are several procedures for addressing the lower lids, the first and foremost being lower lid blepharoplasty. However, the remaining procedures combined with surgical techniques have exclusive implications in thick skin. Understanding the anatomy and various techniques that can be applied to thick skin can help achieve aesthetically more pleasing results in comparison to those of thin skin. As will be discussed in this article, patients with skin color of Fitzpatrick’s grade III or higher have several characteristics associated with their skin, including thicker dermis as well as different patterns of aging, which have implications for addressing the lower lid complex. The senior author has extensive experience performing lower lid procedures and seeks to impart how best to understand and adapt for these differences to allow for the best aesthetic result. [ABSTRACT FROM AUTHOR]

Patients with orbito-temporal neurofibromatosis (OTNF) bear a heavy burden of surgical care. We studied 47 consecutive patients with OTNF from the French Neurofibromatosis 1 Referral Center cohort (n > 900), over a 15-year period to determine the clinical features most likely to predict repeat surgery and longer duration of surgical care. Forty-seven patients (5.2% of the NF1 patients' cohort) underwent 79 procedures with a 4.8 years average follow-up. Soft-tissue surgery had a high revision rate (19/45 patients), skeletal surgery did not (2/13 patients). Transosseous wire canthopexy and facial aesthetic unit remodeling were associated with stable outcome. Ptosis repair carried an unfavorable outcome, particularly in the presence of sphenoid dysplasia. Stable skeletal remodeling was achieved with polyethylene implants and/or cementoplasty. Multiple procedures were undertaken in 70% of patients and were predicted by the NF volume, canthopexy, skeletal dysplasia, or a Jackson's classification 2 and/or 3; but not by declining visual acuity. A classification based upon predictive risk of repeated procedures is proposed: Group 1: Isolated soft tissue infiltration not requiring levator palpebrae or canthal surgery; Group 2: Soft tissue involvement requiring ptosis repair or canthopexy, or NF great axis over 4.5 cm; Group 3: Presence of sphenoid dysplasia with pulsatile proptosis, regardless of visual acuity. [ABSTRACT FROM AUTHOR]

The article presents the study on the use of periocular procedures in paralytic lagophthalmos at Johns Hopkins Medical Institutions in Baltimore, Maryland. The study involved a prospective review of patients from 2006 to 2012. The results reportedly revealed that there is no standard management strategy for paralytic lagophthalmos, however most patients respond well to adjunctive procedures to brow and lower eyelid.

Abstract: Traditional medial canthopexy techniques require transnasal access, periorbital skin incision, and/or direct canthal suturing, often yielding unpredictable outcomes. The transcaruncular canthal barb and miniplate technique is a simplified method of canthopexy that avoids these manoeuvres. 10 transcaruncular medial canthopexies were performed on cadavers with simulated naso-orbito-ethmoid (NOE) injury. Differences in mean pre-injury and post-canthopexy intercanthal distance (ICD) and palpebral aperture width (PAW) measurements were compared using a matched paired t test. Reliability between pre-injury and post-injury intercanthal distance and PAW was compared with intraclass correlation coefficients. Canalicular distortion and final implant position were assessed with post-canthopexy computed tomography (CT). There was no difference in mean palpebral aperture width (32.32 and 32.43mm) or mean intercanthal distance (29.18 and 29.06mm) between pre-injury and post-canthopexy groups (both p >0.05). All intercanthal distance and PAW intraclass correlation coefficients were >0.97 (p <0.05). Post-canthopexy, CT scans showed canaliculus distortion in 4/10 of upper and 0/10 of lower canaliculi with all canthal barbs in the correct position relative to the plate. In a cadaver telecanthus model, medial canthopexy using the transcaruncular barb and miniplate technique reliably reduces the medial canthus and did not distort the lower lacrimal canaliculus, but may distort the upper canaliculus. [Copyright &y& Elsevier]

The article describes the indications and techniques for blepharoplasty of the upper and lower eyelids as well as combinations with other eyelid correction techniques. Upper eyelid blepharoplasty may include skin excision with orbital fat modulation as well as ptosis correction and definition of the superior sulcus palpebralis. The main goal of lower lid blepharoplasty is modulation of intraseptal fat and also often the treatment of a lower lid laxity by canthopexy. It is recommended to avoid excessive skin resection in the lower lid. Furthermore techniques to address an ectropium are reviewed and possible complications of blepharoplasty are presented. [ABSTRACT FROM AUTHOR]

Blepharoplasty is one of the most popular and common procedures in facial plastic surgery. Initially performed in 1818 for eyelid reconstruction, blepharoplasty has evolved to become a cosmetic or functional operation. Although the surgical approaches are relatively straightforward, achieving natural and predictable results require precision and judgment. After performing more than 3500 blepharoplasties, the senior author has learned that the "art of blepharoplasty" has less to do with how much skin or fat is removed and is more about understanding the anatomic changes associated with aging, developing an individualized surgical plan, and anticipating postoperative outcomes or complications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to analyze prospectively 50 patients submitted to lower blepharoplasty allocated to two surgical groups at Federal University of São Paulo, between April 2005 and May 2007. Fifty patients were assigned for interventions into two surgical groups by using random allocation. The SG1 (control group) was composed of 25 patients who were submitted to conservatively standard fat-resection lower blepharoplasty, and routine lateral canthal support. The SG2 (experimental group) was represented by 25 patients submitted to lower blepharoplasty with periorbital fat mobilization and arcus marginalis redrape, and routine lateral canthal support. Preoperative demographic and morphological data from patient charts and standardized photographs obtained before and after surgery were evaluated by an independent observer. Surgical techniques and management of complications were determined from operative reports and clinical notes. The median follow-up was 395 days (range 364 to 547 days). The mean age was 48.8 years; the population’s gender was predominantly female (96%). Analysis of preoperative and postoperative photographs showed that all patients achieved significant improvement. Lateral canthal support was performed in all patients with statistically significant results. The authors concluded that both procedures are safe and effective, with low complication rates. [ABSTRACT FROM AUTHOR]

Background: Ectropion of the lower eyelid can occur after blepharoplasty as well as reconstructive procedures. Even mild ectropion can cause irritation or epiphora. Patients with preexisting lid laxity are at higher risk for post procedure ectropion. Aims: To describe a method for canthopexy and discuss its indications, benefits and limitations. Methods: We describe a technique that has been used on dozens of patients by both the authors. Results: This suspension suture canthopexy corrects mild to moderate ectropion. Discussion: Suspension suture canthopexy is effective in patients with the appropriate indications. It can be performed under local anesthesia with minimal complications. Unlike other forms of lid tightening, it does not change the shape of the eye. Conclusion: Suspension suture canthopexy which is an ancillary procedure for eyelid rejuvenation is valuable procedure to master by the dermatologic surgeon. [ABSTRACT FROM AUTHOR]

Blepharoplasty is one of the most commonly performed operations in plastic surgery, especially among middle-aged patients. Ablative lasers, especially the carbon dioxide laser, assist in tissue cutting and hemostasis. These lasers also offer skin resurfacing with its unique advantages despite the prolonged downtime. The authors present their laser-assisted blepharoplasty experience and the recent addition of one simply performed, inferior lateral retinaculum plication to the procedure (single suture traction technique, SSTT). Hence, the need for laser skin resurfacing of the lower eyelid has been reduced due to the skin traction applied, avoiding the long period required for resolution of erythema and potential hyperpigmentation. Furthermore, the tightening effect on the canthal ligament offers a more youthful look to the surgically treated eye. [ABSTRACT FROM AUTHOR]

Various methods of managing patients with lagophthalmos secondary to paralysis of the facial nerve have been reported. While addition of a gold plate facilitates displacement of the upper eyelid downwards, coaptation of the lid margin is often incomplete because of coexisting ectropion of the lower lid. The outcome obtainable from loading the lid with a gold plate alone is often unsatisfactory. To manage the deformity by combining the loading of the lid with gold plate and lateral canthopexy is technically simple. Morbidity is minimal as it can be done under local anaesthesia. Adequacy of coaption of the palpebral margin could be assessed immediately. We have managed a total of seven (mainly elderly) such patients between 1999 and 2000 in our hospitals. The outcome was generally satisfactory and there were no complications. [ABSTRACT FROM AUTHOR]

Eyelid coupling using the modified tarsoconjunctival flap is an effective treatment for paralytic ectropion. Eyelid position and quality of life can be improved in patients with flaccid facial paralysis using these eyelid coupling procedures. The modified tarsoconjunctival flap can obscure the lateral visual field by coupling the eyelids, but without distortion of the canthal angle and eyelid margin. The procedure is often coupled with a lateral canthoplasty or canthopexy to address horizontal laxity of the lower eyelid. Collecting standardized outcome measures will help establish the ideal treatment paradigm of paralytic eyelid malposition., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: We describe the efficacy of lateral transorbital canthopexy using a silicone tube in managing severe paralytic ectropion., Methods: Patients with paralytic ectropion involving at least two-third of lower eyelid length and scleral exposure of 3 mm or more were considered. A silicone prosthetic was inserted during canthopexy., Results: Lateral transorbital canthopexy using a silicone tube was performed on 10 eyelids in nine patients. All patients had corneal surface abnormalities. Scleral exposure resolved completely in three cases. At 8-month follow-up, residual scleral exposure of 1 mm and 2 mm persisted in n  = 6 and n  = 1 cases, respectively., Conclusions: Lateral transorbital canthopexy using a silicone tube is an effective therapeutic option for paralytic ectropion, facilitating both functional and cosmetic results that proved durable over time.

Aesthetic canthal suspension can be an effective adjunct to lower eyelid blepharoplasty. Understanding the anatomy and function of the lateral canthal tendon is critical for preoperative evaluation and surgical decision making. In this article, the authors discuss the lateral canthal terminology, anatomy, and aging changes. Various canthal suspension procedures, including open and closed canthal suspension, commissure sparing open canthoplasty, and canthopexy, are described. Finally, the preoperative evaluation, postoperative course, and complications of surgery are reviewed., Competing Interests: Disclosure Dr G.G. Massry received royalties from Elsevier, Springer, Quality Medical Publishers, and Osmotica Pharmaceuticals. Dr. Holds received royalties from Springer, and is a consultant and shareholder for Horizon Pharmaceuticals, and a shareholder of Cypris Medical, Revance Thereapeutics and Panbela Therapeutics. Dr R.S. Douglas received Royalties from Springer, Osmotica Pharmaceuticals, and Horizon Pharmaceuticals., (Copyright © 2021 Elsevier Inc. All rights reserved.)