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Original Investigation |

A Quantitative Analysis of Lateral Canthal Position Following Endoscopic Forehead-Midface–Lift Surgery

Christopher K. Kolstad, MD1,2; Vito C. Quatela, MD1
[+] Author Affiliations
1Department of Facial Plastic and Reconstructive Surgery, Lindsay House Center for Cosmetic and Reconstructive Surgery, Rochester, New York
2now with the Department of Facial Plastic and Reconstructive Surgery, Kolstad Facial Plastic Surgery, La Jolla, California
JAMA Facial Plast Surg. 2013;15(5):352-357. doi:10.1001/jamafacial.2013.1220.
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Importance  The value of this study is to evaluate outcomes of endoscopic forehead-midface–lift surgery. Many surgeons are reluctant to offer this procedure for fear of change in the shape and appearance of the eyelid.

Objective  To objectively evaluate the change in lateral canthal position following endoscopic forehead-midface–lift surgery.

Design  A retrospective review of consecutive patients undergoing endoscopic forehead-midface–lift and lower blepharoplasty procedures for cosmetic midface rejuvenation.

Setting  A private facial plastic surgery practice.

Participants  Photometric data were obtained from before-and-after surgery images from 40 patients.

Main Outcomes and Measures  All photographs were analyzed to determine the horizontal width, vertical height, palpebral fissure width, or angle between the medial and lateral canthi. The right and left eyes were evaluated independently, with the results analyzed using a 2-tailed paired t test with a confidence interval of 0.05 or less (required for statistical significance).

Results  The results indicated no statistically significant change in the horizontal width (right, P = .25; left P = .07), vertical height (right, P = .99; left, P = .72), palpebral fissure width (right, P = .28; left, P = .48), and angle of the lateral canthus (right, P = .99; left, P = .30) before and after surgery.

Conclusions and Relevance  The endoscopic forehead-midface–lift is a reliable method of addressing midface descent. This study objectively identified no significant differences in the position of the lateral canthus before and after surgery.

Level of Evidence  4.

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Figure 1.
Before and After Endoscopic Forehead-Midface–Lift

Preoperative (A and C) and postoperative (B and D) photographs after endoscopic forehead-midface–lift.

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Figure 2.
Points Measured for Statistical Analysis

In the right eye, horizontal visible iris diameter (HVID) is marked by yellow line. In the left eye, circular points mark the medial canthus (MC) and lateral canthus (LC). X represents the horizontal width between the MC and LC marked by yellow line; Y, the vertical distance between the MC and LC; and Z, the palpebral fissure width.

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Figure 3.
Preserved Area of Undissected Periosteum

A minimum of 2 cm2 of periosteum in the region of the lateral canthus should remain undisturbed to prevent lateral canthal distortion. A, Undissected periosteum shaded in red. B, Corresponding soft tissue overlying preserved periosteum shaded in red.

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