|
Primary goal: The main goal of canthopexy is to strenthen support of the lateral canthal tendon at the outer corner of the eyelids.
Secondary goals: While canthopexy is sometimes said to less the chance of eyelid malposition after blepharoplasty undertaken from the skin surface of the lower lid, any protective effect is temporary and usually insufficient in more than very conservative cases.
Operation: Canthopexy is seldom undertaken as a stand-alone procedure but is rather an added component of full lower blepharoplasty.
A skin incision exposes the orbicularis muscle in the lower eyelid. At the outer corner, two stitches are introduced into the muscle and then angled upward to engage the lateral canthal tendon and its surrounding retinaculum. The suture then passes upward towards the bony rim, where the needles are passed through the periosteum lining the bone. Tied to one another, the sutures provide added support to both canthal tendon and retinaculum.
Variations: Techniques may vary surgeon to surgeon, some of whom describe the procedure as a "simple stitch" in the corner. Unfortunately, such slap-dash procedures do not often identify the proper anatomy or achieve the added support. Even well-performed, the procedure does not produce cut edges that promote a more permanent effect but only a temporary cinching up of tissue. Consequently, much of the effect is fleeting.
Advantages: If skin removal is needed but eyelid support at the outer corner is weak, the added tension may overpower a weak canthal system. Canthopexy can allow for temporary stronger fixation during healing. Canthopexy will not, however, prevent lower eyelid retraction when employed during the older method of transcutaneous approach to the orbital fat.
Risks and complications: Swelling on the both the eyelids and eyeball can be increased after canthopexy due to interference with the lymphatic drainage (chemosis). While this is temporary, it may persist for several weeks and rarely several months. While some surgeons routinely empoy canthopexy in all low lid blepharoplasty, a better approach seems to be emply safer procedures that do not stress the eyelid's normal support system.
|
