Primary goal: Strengthening the lateral canthal tendon and/or orbicularis muscle at the outer corner of the eyelids (lateral canthus).
Secondary goals: Preventing ectropion (an eversion of the eyelid away from the eye) with transcutaneous lower blepharoplasty.
Operation: Tarsal strip resuspension (one variation): Scissors are placed at the junction of the outer upper and lower eyelids (the lateral commissure) and a full-thickness cut is made into the lateral canthus towards the orbital bony rim. The lower half of the lateral canthal tendon extending from the bony rim into the lower eyelid is isolated and cut free from its attachment to the bone. An incision is made on the eyelid margin a small distance (approximately 1/5 inch) from the cut tendon, and the tarsal plate closest the tendon is cleaned of all adherent skin and conjunctiva. This creates a small strip of tarsal plate tissue, a cartilage-like structure that will be used to create "a new and tighter tendon". A non-absorbable suture is used to sew this strip of tarsal plate to the periosteum (the lining of the bone) located just inside the socket's bony rim. The attachment is reinforced with dissolving sutures, and the overlying muscle and skin are closed.
Variations: There are many variations in surgical technique, which allow for the amount of reinforcement to range from mild to marked. A common variation on lateral canthal tendon tightening is to "tuck" the orbicularis muscle (as opposed to working with the tarsal plate) by pulling it upward and sewing it to the underlying periosteum at the orbital bony rim ("lateral canthal plication", "lateral canthoplasty", etc.).
Advantages: If the lateral canthal tendon and orbicularis oculi muscle are stretched, tightening restores the normal support to the rest of the lower eyelid. Not only does this help to prevent ectropion both at the time of surgery and some years later, but it also creates a slight upward pull on the lid that softens wrinkles and improves the eye's handling of tears.
Risks and complications: If not well performed, the lateral commissure (the junction between the upper and lower eyelids) may become round or deformed.
