title: Medial tarsal suspension: a method of elevating the medial lower eyelid.
abstract: OBJECTIVE
  When attempting to elevate the lower eyelid for any reason, medial elevation is the most difficult to attain. Medial canthal tendon tightening creates mostly horizontal tension and contributes little vertical vector. We present a technique for applying a lifting force to the medial end of the eyelid: medial tarsal suspension.
  
  
  METHODS
  The technique to suspend the medial lower eyelid tarsal plate to the superior orbital rim periosteum is described. The procedure, medial tarsal suspension (MTS), was performed on 38 lower lids of 24 patients. Adjunctive procedures, most commonly lateral canthal sling, were performed on 66% of the lids at the time of the initial medial tarsal suspension. The patients ranged in age from 29 years to 84 years. All had medial lower eyelid retraction, with facial nerve palsy, Graves eye disease, involutional lower eyelid retraction, and forms of muscular dystrophy the commonest etiologies.
  
  
  RESULTS
  Thirty-one (82%) of the 38 MTS procedures were successful. There was no unifying factor among the seven failed procedures in five lids of five patients. Three of the five patients, including two who were operated on twice, ultimately had a successful MTS. This procedure was not repeated on the other two failed patients. Range of follow-up was 9 months to 5.6 years, with a mean of 3.7 years. The mean elevation of the central lower eyelid was 1.6 mm in the successful cases.
  
  
  CONCLUSIONS
  Medial tarsal suspension is an effective way to elevate the medial end of the lower eyelid.
authors.affiliation: Eye Plastic and Orbital Surgery Service, Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, USA.
authors.forename: Bartley R
authors.initials: BR
authors.lastname: Frueh
authors.forename: Charles S
authors.initials: CS
authors.lastname: Su
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D004483:Ectropion / Q000601:surgery; D005141:Eyelid Diseases / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques