title: Lateral canthal resuspension sine canthotomy.
abstract: OBJECTIVE
  The purpose of this study is to describe a novel canthopexy technique-the lateral canthal resuspension sine canthotomy (LCR-SC)-performed via an upper-eyelid incision and to compare it with the lateral tarsal strip procedure (LTS).
  
  
  METHODS
  This is a retrospective study in which the pre- and postoperative photographs of 20 patients per group who had LCR-SC, LCR-SC + midface lift (LCR-SC+ML), or LTS were analyzed by using the Image-J 1.40 software. Parameters measured were as follows: the horizontal palpebral aperture margin-reflex distance 2 (MRD-2) and the height of lateral canthus. LCR-SC was performed through an upper-eyelid incision, by using a 4.0 Prolene suture. For the LCR-SC+ML, a large myocutaneous flap was created first and anchored to the orbital-rim periosteum. The surgical technique is described. Two-way ANOVA was used for analysis.
  
  
  RESULTS
  The horizontal palpebral aperture was significantly increased by LCR-SC and LCR-SC+ML when compared with LTS (1.61 ± 0.22 mm and 1.56 ± 0.14 vs. 0.04 ± 0.12 mm; p < 0.01). LCR-SC and LCR-SC+ML decreased the MRD-2 more than the LTS (1.06 ± 0.26 and 1.50 ± 0.23 mm vs. 0.86 ± 0.1 mm; p < 0.01). All 3 procedures increased the lateral canthal height by less than 0.5 mm.
  
  
  CONCLUSIONS
  LCR-SC is a safe and effective procedure for tightening the lower eyelids. It tightens both the upper and the lower cruri of the lateral canthal tendon, avoiding imbrication of the eyelids. LCR-SC obviates the need for a lateral canthal incision and widens the horizontal palpebral aperture. LCR-SC is more effective than LTS at decreasing the MRD-2. Concomitant midface elevation (LCR-SC+ML) further decreases MRD-2.
authors.affiliation: Johns Hopkins Medical Institute, Baltimore, MD, USA. dan.oculoplastics@gmail.com
authors.forename: Dan
authors.initials: D
authors.lastname: Georgescu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Anderson
authors.forename: John D
authors.initials: JD
authors.lastname: McCann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005141:Eyelid Diseases / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010781:Photography; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*