Transcaruncular Approach to Medial Canthal Tendon Plication for Lower Eyelid Laxity

Fante, Robert G.; Elner, Victor M.

doi:10.1097/00002341-200101000-00004

Cited by 60 publications

(40 citation statements)

References 33 publications

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“…Because of stretching of the tarsal-ligamentous support of the lower lid, lateral canthal ligament tightening was performed in all cases. Medial canthal ligament tightening as described by Fante and Elner 20 was used in 6 cases to restore medial lower lid position and assist in ameliorating lacrimal pump dysfunction. Hard palate mucosal grafting was perfomed in 6 patients to add rigidity and fullness to the lax and atrophic lower lids.…”

Section: Resultsmentioning

confidence: 99%

“…6 Medial eyelid laxity was addressed by medial canthal ligament tightening as previously described by Fante and Elner. 20 Hard palate mucosal grafting was performed to improve lower lid rigidity and lengthen the posterior lamella, when judged to be necessary. 13,14 Static lower facial slings consisting of 10ϫ1-mm expanded perfluorotetraethylene strips from the nasal ala or oral commissure to the lateral surface of the zygoma were used to relieve nasal obstruction or oral symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…We also addressed medial and lateral canthal ligament laxity, eliminating the need for tarsorrhaphy in our patients. In particular, the medial canthal ligament tightening we performed 20 provides posterior wrapping and elevation of the eyelid around the eye, thereby permitting repair of difficult-to-treat medial lower laxity, which otherwise may require medial tarsorrhaphy despite midfacial lifting as described by Olver. 2 The hard palate mucosal grafting we used complemented the deep tissue support provided by midfacial elevation to increase viscoelastic support for the skin and orbicularis muscle in our study (Figures 1-3).…”

Section: Commentmentioning

confidence: 99%

See 2 more Smart Citations

Comprehensive Midfacial Elevation for Ocular Complications of Facial Nerve Palsy

Elner

Mauffray

Fante

et al. 2003

Arch Facial Plast Surg

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

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Comprehensive Midfacial Elevation for Ocular Complications of Facial Nerve Palsy

Elner

Mauffray

Fante

et al. 2003

Arch Facial Plast Surg

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“…1 This technique demonstrated promise in our initial study 1 by resolving symptoms in 23 eyelids of 15 patients during a mean follow-up period of 12 months. In this study, we report the results using this method on 176 eyelids of 125 patients followed up for an average of 2 years.…”

Section: Commentmentioning

confidence: 94%

Transcaruncular Medial Canthal Ligament Plication for Repair of Lower Eyelid Malposition

et al. 2007

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To evaluate the long-term efficacy of transcaruncular medial canthal ligament (MCL) plication in the treatment of eyelid malposition.Methods: Transcaruncular MCL plication was performed on 176 eyelids of 125 patients with symptomatic ocular exposure due to lower eyelid malposition in which MCL laxity was an important component. Preoperative and postoperative ocular exposure symptoms, lower eyelid position, lagophthalmos, and keratopathy were compared.Results: At an average ± SD follow-up time of 25 ± 27 months (range, 1-103 months), 88% of preoperative symptoms resolved or improved. Lower eyelid position (PϽ.001), lagophthalmos (PϽ.001), and keratopathy (PϽ.001) were significantly improved. In 11% of eyelids undergoing MCL plication as the only repair, results were comparable with those in which other repairs were performed concurrently. Complications were suture breakage in 2 cases and pyogenic granuloma in 1 case.Conclusions: Transcaruncular MCL plication is a safe and effective technique for MCL laxity that contributes to lower eyelid malposition. This minimally invasive technique achieves good functional and cosmetic outcomes by re-establishing the vectoral forces for eyelid support that are normally provided by the tripartite ligament.

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“…Fante and Elner describe a transcaruncular orbital approach for medial canthal tendon plication to improve postoperative medial eyelid position, correction of epiphora, and superficial punctate keratopathy (Level IV Evidence). 39 For the treatment of moderate lower eyelid laxity, Lessa and Nanci described a lateral canthopexy technique without canthotomy that avoids release of the lateral canthal tendon in 316 patients (Level IV Evidence). 40 To smooth the external surface of the lower eyelids or reduce fine periorbital rhytids, injection of fat or dermal fillers and laser or chemical resurfacing are occasionally performed at the same time as surgery, depending on the techniques utilized.…”

Section: Evidence On Surgical Treatment Planmentioning

confidence: 99%

An Evidence-Based Approach to Blepharoplasty

Friedland

Lalonde

Rohrich

2010

Plastic and Reconstructive Surgery

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The Maintenance of Certification module series is designed to help the clinician structure his or her study in specific areas appropriate to his or her clinical practice. This article is prepared to accompany practice-based assessment of preoperative assessment, anesthesia, surgical treatment plan, perioperative management, and outcomes. In this format, the clinician is invited to compare his or her methods of patient assessment and treatment, outcomes, and complications, with authoritative, information-based references.This information base is then used for self-assessment and benchmarking in parts II and IV of the Maintenance of Certification process of the American Board of Plastic Surgery. This article is not intended to be an exhaustive treatise on the subject. Rather, it is designed to serve as a reference point for further in-depth study by review of the reference articles presented. (Plast. Reconstr. Surg. 126: 2222 CLINICAL SCENARIOA 56-year-old woman requests improvement in the appearance of her upper and lower eyelids. She had LASIK surgery 3 months earlier. She has ptosis of her left upper eyelid. What is the best evidence to guide you in the management of her condition? There is very little high level evidence in the blepharoplasty literature at this time. The age of evidence is just upon us, and objective measurement in aesthetic surgery is in its infancy. This article is a starting point where most of the evidence is level IV (case series) and level V (case reports or expert opinion). There is almost no level III evidence (retrospective comparative case series) and virtually no level II evidence (prospective comparative studies). It will be very difficult to create level I studies that are prospective randomized blinded controlled studies. Nevertheless, we have to start somewhere. One hundred years from now, there will be serious useful evidence-based studies in cosmetic plastic surgery, like looking from the top of a sky scraper. This is the first step at examining where we are in the basement of evidence based medicine in aesthetic blepharoplasty. METHODS FOR IDENTIFYING EVIDENCEA literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library was performed to obtain the best available evidence on blepharoplasty, with emphasis on preoperative assessment, treatment, and outcomes. The following search terms were combined as appropriate, and PubMed MeSH terms were used when available: blepharoplasty, eyelid surgery, diagnosis, preoperative assessment, risk factors, smoking, diabetes mellitus, pulmonary embolism, venous thrombosis, dry eye syndromes, anticoagulants, DVT prophylaxis, antibiotic prophylaxis, anesthetics, premedication, surgical treatment plan, treatment, surgery, outcome, complications, postoperative complications, pain management, and analgesia. The initial search was limited to human studies that were published from 1999 to 2009 and indexed as metaanalyses, randomized controlled trials, clinical trials, or comparative studies. Very fe...

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Transcaruncular Approach to Medial Canthal Tendon Plication for Lower Eyelid Laxity

Cited by 60 publications

References 33 publications

Comprehensive Midfacial Elevation for Ocular Complications of Facial Nerve Palsy

Comprehensive Midfacial Elevation for Ocular Complications of Facial Nerve Palsy

Transcaruncular Medial Canthal Ligament Plication for Repair of Lower Eyelid Malposition

An Evidence-Based Approach to Blepharoplasty

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