0
Surgical Technique |

The Lateral Tarsal Strip Mini-Tarsorrhaphy Procedure

M. Reza Vagefi, MD; Richard L. Anderson, MD
Arch Facial Plast Surg. 2009;11(2):136-139. doi:10.1001/archfaci.11.2.136.
Text Size: A A A
Published online

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.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Figure 1.

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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

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.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

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.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Orbitomalar suspension with combined single drill hole canthoplasty. Ophthal Plast Reconstr Surg 2013 Sep-Oct;29(5):357-60.
Jobs
brightcove.createExperiences();