Managing the Lateral Canthus in the Aesthetic Patient

Abstract

Lateral canthal suspension is an essential component of lower eyelid surgery. Unfortunately, the lateral canthus is a complex and delicate anatomic structure whose position, appearance, and function can be difficult to maintain or recreate after surgery. This has made canthoplasty a somewhat confusing, intimidating, and controversial area of surgery for aesthetic eyelid surgeons. Early descriptions of the procedure were restorative in nature with an emphasis on correcting eyelid pathology (ectropion, retraction, etc.). Surgery involved lower eyelid disinsertion and shortening. While this lateral tarsal strip procedure is powerful, significantly improves eyelid position, and yields consistently excellent results, it can also alter the position and appearance of the canthus. In aesthetic eyelid surgery, the goal is to not to restore function, but rather to enhance appearance without disturbing function. This requires canthal procedures which support the eyelid but are less distorting of anatomy. A modified canthoplasty, in which the lower lid is reinforced to bone, without its disinsertion or shortening, or a canthopexy, where the orbicularis muscle is used to support the lower lid, can be performed to accomplish this goal. These procedures are not only less powerful than traditional canthoplasty but also simpler and quicker, and yield less postoperative complications. They are a necessary step in lower eyelid blepahroplasty surgery and can be mastered with experience.