Prophylactic lateral canthopexy in lower blepharoplasties

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 5 years in my practice, 247 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, I 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.