Minimally invasive lateral canthopexy (MILC)

Simple Incisionless Temporary Stabilization: An Adjunct to Lower Blepharoplasty

Background

Lateral canthal tightening is indicated for patients undergoing lower eyelid blepharoplasty who have preexisting lower eyelid laxity or ectropion. A canthoplasty or canthopexy is indicated at the time of lower blepharoplasty to avoid postoperative complications, such as eyelid retraction or ectropion. Various surgical techniques are described to accomplish this goal, including canthopexy procedures, which usually access the lateral canthal tendon through an upper eyelid blepharoplasty or lateral canthal incision.

Objectives

To describe an incisionless technique adjunctive to lower blepharoplasty, which stabilizes the lower eyelid in the week following blepharoplasty.

Methods

This operative technique description and retrospective case series includes 15 patients who underwent a simple incisionless temporary stabilization (SITS) during lower eyelid blepharoplasty. The procedures were performed at the same outpatient office-based surgery center and were performed by the author surgeons. Patients were followed from 3 to 6 months postoperatively.

Results

The SITS procedure during lower eyelid blepharoplasty successfully maintained a desirable functional and aesthetic eyelid position with minimal complications. One patient reported tearing postoperatively which was determined to be unrelated to the SITS and resolved by the 1-month follow-up visit. No patient had any other complications during the follow-up period.

Conclusions

The SITS procedure was successfully utilized in patients with mild-to-moderate lower eyelid laxity and/or a negative vector to prevent postoperative ectropion and eyelid retraction. It is a more favorable alternative to temporary tarsorrhaphy, as it does not obstruct vision during healing and better secures the eyelid. It should not be used in patients with significant lower eyelid laxity that would place the patient at significant risk of ectropion and lower eyelid retraction related to swelling and inappropriate eyelid position during the early postoperative course.

Level of Evidence 4

Simplified technique for lateral canthal tendon canthopexy

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.

Burn Scar Ectropion Correction: Surgical Technique for Functional Outcomes

BACKGROUND

Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to asymmetry and malposition of the eyelid axis, resulting in corneal exposure, eyelid retraction, and incomplete eyelid closure. In consequence, dryness and irritation of the cornea can lead to keratitis, corneal opacity, and vision impairment. In this study, we present our surgical technique for lateral canthopexy in combination with full-thickness skin grafting (FTSGing) in patients with eyelid axis distortion after scar contraction of the periorbital region after severe burn injuries of the face.

METHODS

In this retrospective, single-center case study, we present 5 consecutive patients who experienced severe burn injuries to the face between 2014 and 2019. Patients were suffering from ectropion and malposition of the eyelid axis. In all cases, we performed lateral transosseous canthopexy and FTSGing.

RESULTS

Improved symmetry and complete eyelid closure were restored in all 5 patients. The following ophthalmological examinations showed resolved corneal erosions, as well as reduction of chemosis and epiphora. Further vision impairment was successfully prohibited. Surgical revision with FTSGing was required in 2 patients because of recurrence of unilateral lower eyelid retraction.

CONCLUSIONS

Lateral transosseous canthopexy represents a suitable surgical method to durably correct eyelid malposition, ectropion, and incomplete lid closure in patients with severe scarring of the periorbital region after burns of the face. Early detection of patients at risk and timing of surgical intervention are of great importance.

Surgical preferences for lateral canthoplasty and canthopexy

PURPOSE OF REVIEW

To describe the currently used techniques of lateral canthal tightening and their indications.

RECENT FINDINGS

The treatment of involutional ectropion involves horizontal tightening of the lower eyelid via a lateral canthal resuspension procedure, which can be either a canthopexy or a canthoplasty. The lateral tarsal strip, one of the most common canthoplasty procedures performed today, is a powerful technique, very useful in cases of profound eyelid laxity or ectropion in which horizontal eyelid shortening is necessary to achieve adequate eyelid tightening.For less-severe eyelid laxity, a canthopexy can be performed through either an upper or a lower eyelid incision, in which the suture is passed through the eyelid incision without externalization at the lateral canthal angle. We recently described the lateral canthal resuspension sine canthotomy technique that was slightly more effective than the lateral tarsal strip at decreasing the MRD-2 and lengthened the horizontal palpebral aperture without significantly changing the lateral canthal height.

SUMMARY

Although the lateral canthal resuspension sine canthotomy technique has advantages for tightening loose lower eyelids in both cosmetic and functional cases, the lateral tarsal strip remains the procedure of choice for severe lid laxity or ectropion.