The lateral canthus normally sits 1 to 2 mm higher than the medial canthus. With time, aging and gravity produce inferior displacement of the canthus. Numerous eyelid disorders can also result in lower eyelid or lateral canthal tendon laxity or malposition, requiring horizontal eyelid tightening or canthal repositioning. The lateral tarsal strip procedure has proven to be a useful technique in addressing these problems. Care must be taken when suspending the tarsal strip to the lateral orbital rim to preserve the almond shape of the lateral canthal angle. If mild to moderate upper eyelid laxity is present, suspension of the strip can result in upper eyelid overhang with lower eyelid and eyelash imbrication. We describe the lateral tarsal strip mini-tarsorrhaphy procedure that overcomes this problem. The technique provides excellent functional and aesthetic results and adds to the versatility of a time-tested procedure.
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Upper eyelid overhang with lower eyelid and eyelash imbrication after standard lateral tarsal strip procedure. A 75-year-old man with lower eyelid ectropion and moderate upper eyelid laxity had a lateral tarsal strip procedure with appropriate height placement of the strip. Immediate postoperative photograph of the right side demonstrates lateral overhang of the upper eyelid with lower eyelid and eyelash imbrication.
The lateral tarsal strip mini-tarsorrhaphy procedure. A, A lateral canthotomy is performed. B, The inferior crus of the lateral canthal tendon is released. C, The anterior lamella is dissected from the tarsus. D, The lateral lash line and mucocutaneous junction are removed. E, An incision is made across the lower edge of the tarsus, releasing the conjuctiva and temporal lower eyelid retractors. F, A blade is used to remove the palpebral conjunctiva over the strip. G, The tarsal strip is shortened by an adequate amount. H, A small portion of the superior eyelid mucocutaneous junction is removed. I, A full-thickness pass is made with the suture through the superior aspect of the tarsal strip. J, The P-2 needle is rotated through the periostium along the inside of the lateral orbital rim just superior to the insertion of the lateral canthal tendon. K, The needle is then passed through the denuded superior eyelid margin from the posterior side of the lateral portion of the upper eyelid. L, The suture is secured and tied to itself. A second suture can be placed before securing the first for additional support of the tarsal strip.
Preoperative and postoperative examples of the lateral tarsal strip mini-tarsorrhaphy (LTSM) procedure. A, A 61-year-old man presented with bilateral involutional ectropion, worse on the right than left, in conjunction with mild upper eyelid laxity. B, Follow-up 4 months after bilateral LTSM procedure in conjunction with upper eyelid blepharoplasty demonstrates correction of ectropion and improvement of the lateral canthal angles. C, A 53-year-old woman with moderate cicatricial right lower eyelid retraction, 3 mm of inferior scleral show, and mild upper eyelid laxity presented after prior 4-lid blepharoplasty that was complicated by necrosis of the right lower eyelid requiring a skin graft. D, At 3 months’ follow-up after a right unilateral LTSM procedure was performed in conjunction with release of the lower eyelid retractors and a myocutaneous flap, resolution of right lower eyelid retraction is noted with improved symmetry with the contralateral side. E, An 80-year-old man presented with bilateral lower eyelid retraction and moderate upper eyelid laxity. F, A bilateral LTSM procedure was performed, demonstrating resolution of lower eyelid retraction, symmetry of the fissures, and sharp lateral canthal re-formation at 3 months.
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