Recent progress in cosmetic lateral canthoplasty / 中华整形外科杂志

The lateral canthus is the junction of the upper and lower eyelids, which is located at the temporal side. The distance from the lateral orbit rim to the lateral canthal angle is 5-7 mm. Cosmetic lateral canthoplasty, as an important surgical method for the rejuvenation of the eyes, was developed in recent year. Along with the development of anatomic study of the lateral canthus, the cosmetic lateral canthoplasty was modified and improved. The purpose of this review is to summarize the anatomy of the lateral canthus, indications for cosmetic lateral canthoplasty and surgical procedures, so as to provide a useful reference for clinicians.

Cosmetic lateral canthoplasty / 中华整形外科杂志

" Cosmetic lateral canthoplasty" and " vertical enlargement of the palpebral aperture" have been in heated discussion in the field of cosmetic surgery in recent years.The author attempted to summarize and analyze both surgeries, including the history of technical evolution, anatomical basis, clinical research and complications, in order to provide a clear and correct understanding.

Cosmetic Lateral Canthoplasty: Lateral Canthoplasty to Lengthen the Lateral Canthal Angle and Correct the Outer Tail of the Eye

There are many women who want larger and brighter eyes that will give a favorable impression. Surgical methods that make the eye larger and brighter include double eyelidplasty, epicanthoplasty, as well as lateral canthoplasty. Double eyelidplasty produces changes in the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty create changes in the horizontal dimension of the eyes. Epicanthoplasty, a surgical procedure which enlarges the eye horizontally, is performed at the inner corner of the eye, whereas lateral canthoplasty enlarges the outer edge of the eye. In particular, if the slant of the palpebral fissure is raised and the horizontal dimension of the palpebral fissure is short, adjusting the slant of the palpebral fissure through lateral canthoplasty can achieve an enlargement of eye width and smoother features. Depending on the patient's condition, even better results can be achieved if this procedure is performed in conjunction with other procedures, such as double eyelidplasty, epicanthoplasty, eye roll formation surgery, fat graft, and facial bone contouring surgery. In this paper, the authors will introduce in detail their surgical method for a cosmetic lateral canthoplasty that lengthens the lateral canthal angle and corrects the outer tail of the eyes, in order to ease the unfavorable impression.

Effective Lateral Canthal Lengthening with Triangular Rotation Flap

In Korea, lateral canthoplasty, along with medial epicanthoplasty, has become popular over the past years to widen the horizontal length of the palpebral fissure. However, the effect of the surgery differs greatly depending on the shape and structure of the eyes. If over-widened, complications such as eversion, scarring, and conjunctival exposure may occur. Thus, the author of this study suggests a more effective and safe method for lateral canthal lengthening that causes minimal complications. A total of 236 patients underwent lateral canthoplasty between July 2007 and December 2015. For each patient, a triangular flap 4-5 mm away from the lateral canthus was elevated and rotated 45 degrees laterally while the continuity of the lower eyelid gray line was maintained. A new lateral canthus was created by fixating the rotation flap to the lateral orbital rim with minimal skin trimming and tension-free sutures, preventing relapse and maintaining a triangular shape. In more than 95% of cases, effective and satisfactory extension was achieved. On average, a 3 mm extension of the lateral canthus was achieved. There were minor complications such as wound dehiscence, webbing, and scarring, which were easily corrected. The author not only extended the lateral canthus 3-4 mm laterally but also maintained the continuity of the gray line on the lower lid as a more natural-looking triangular shape, while minimizing complications such as webbing and conjunctival exposure.

Efficacy of Lateral Canthoplasty Combined with Transconjuctival Lower Blepharoplasty in Young Asian Patients

BACKGROUND: The lower eyelid bag associated with an old and tired appearance is not a rare aesthetic problem in young Asian people who have short palpebral fissures and an up-slanting appearance. Many patients want to make their eyes larger, brighter and more youthful at the same time. The purpose of the current study was to determine the feasibility of lateral canthoplasty combined with transconjunctival lower blepharoplasty in minimizing complications and maximizing aesthetic results. METHODS: From June 2011 to May 2014, 59 patients underwent inferior orbital fat removal and orbital septal resets through transconjunctival approaches and lateral canthoplasty. Simple inferolateral canthotomy incisions were used to provide a sufficient operative field for manipulation of the orbital septum, to lengthen the horizontal palpebral fissures and to lower the lateral canthal angle. Patients were evaluated to identify the presence of postoperative complications and to assess the need for additional operations. RESULTS: Most of the patients were satisfied with the aesthetic results during the 2-12-month postoperative follow-up period. There were no recurrences of lower eyelid bulging, postoperative asymmetry, or wound-related complications. Three cases of entropion and two cases of roundness of the lateral canthal angle occurred following the primary operation. However, there were no further complications after secondary operations to correct the tarsal-periosteal fixation position. CONCLUSIONS: Lateral canthoplasty combined with transconjunctival lower blepharoplasty using simple lateral canthotomy is a safe and effective method for maximizing aesthetic results in young Asian patients.

Transconjunctival Lowering of the Lateral Lower Eyelid by Shortening of the Posterior Lamellae

Commonly, the lateral canthus is located higher than medial canthus and many people are often shown short lateral palpebral fissure. This seemed to be shown as wild, anxious, and pierced eye. Many surgeons have made desperate efforts to improve this by anchoring lateral canthus to lower part of orbital bone. But, authors would like to show the two-third portion of the lateral lower eyelid by anchoring to capsulopalpebral fascia via transconjunctival approach. Authors performed this operation since 2009 and first named it by "Nun-Mit-Teuim" in Korean. Key of this operation is that anchoring of the lower tarsus and capsulopalpebral fascia via transconjunctival approach without resection of skin. It is not necessary to remove a redundant conjunctiva. Commonly, the lateral canthoplasty is performed simultaneously to descend a lower eyelid easily. After the operation, it can be observed that the lower eyelid lift up a little bit for 1~2 weeks and redundant conjunctiva will be constricted in several months. The operation is defined as anchoring the lower tarsus to capsulopalpebral fascia. The limit of the operation is it cannot change the position of the lateral canthus. Over-lowering the lower eyelid to increase palpebral fissure, results in scleral show and unfavorable line. Thus, it is important that surgeons should remind the purpose and limitation of this operation.

Lateral Canthoplasty Using Lateral Cantotomy and Y-V Advancement

PURPOSE: Lateral canthoplasty is utilized in aesthetic surgery to lengthen the lateral palpebral fissure of the lateral canthal area. However, complication such as recurrence, contour deformity or hypertrophic scar make its results doubtful. Therefore, we developed lateral canthoplasty with lateral canthotomy and Y-V advancement to effectively lengthen the palpebral fissure without recurrence. METHODS: A total number of 117 patients were reviewed from March 1991 to April 2005. The operative procedure was lateral canthoplasty with lateral canthotomy and Y-V advancement. To prevent recurrence, we dissected lateral conjunctiva of lower eyelid and cutted retaining ligament. The author believes that by this procedure, V flap would be able to advance laterally without tension. RESULTS: We performed lateral canthoplasty in 117 patients. There were no recurrence and patients were satisfied with the results. There were 12 patients who presented with complication. Complication included hypertrophic scar in 4 patients, web formation in 3 patients and over-correction in 5 patients. CONCLUSION: Lateral canthoplasty with lateral canthotomy and simple Y-V advancement may be used as an effective method to lengthen palpebral fissure without recurrence.

Lateral canthal anchoring for correction of lower eyelid retraction / 中华医学美学美容杂志

Objective To investigate the ideal methods for correction of lower eyelid retraction by lateral canthal anchoring.Methods The authors retrospectively reviewed the records of 126 patients(207 eyelids) operated on between June 1999 and 2005 by one senior surgeon.The age of the patients ranged from 28 to 72 years(mean,46 years).Transcanrhal canthopexy was used in 20 patients(33 eyes);The 3 mm tarsal strip procedure was used in 35 patients(57 eyes);Transcanrhal canthopexy combined with Hamra's lower blepharoplasty was used in 26 patients(45 eyes).The tarsal strip procedure combined with Hamra's procedure was used in 45 patients(72 eyes).75 patients(123 eyes) were followed up for 6～12 months.Mean follow-up time was 8 months. Results Of them,125 patients were uniformly satisfied with their cosmetic and functional outcome at last follow-up;one patient had undercorrection of retraction.There were no major complications and only one minor complications(corneal irritation from graft sutures),which resolved in the early follow-up period.Conclusions The lateral canthal anchoring is an effective,aesthetic,and functional treatment for moderate to severe lower eyelid retraction resulting from multiple causes.This procedure is associated with predictable results,a low morbidity rate,and high patient satisfaction.

Surgical Correction of Lower Lid Retraction Using The Scleral Spacer

Lower lid retraction can be caused by many etiologies but few require surgical intervention except for cosmetic reasons and exposure deratitis due to lagophthalmos. We report three lower lid retraction patients who underwent lower lid reconstruction was due to congenital etiology or was secondary to excessive inferior rectus muscle recession or lower lid blepharoplasty due to orbital neurofibroma. All three patients found their results satisfactory and showed no severe side effects during the follow-up period. It is suggested that the use of scleral spacer combined with lateral canthoplasty be an effective surgical procedure for correction of lower lid retraction.