title: Tarsal sling: an essential stitch to prevent scleral show in lower blepharoplasty.
abstract: BACKGROUND
  Despite its popularity for facial rejuvenation, blepharoplasty has been associated with several adverse effects. One of the most common is eyelid displacement after lower transcutaneous blepharoplasty. The tarsal sling procedure affixes the external portion of the septum (the lateral canthal ligament) to the internal orbital wall periosteum with a simple suture. This simplified canthopexy decreases the risk of lower eyelid margin displacement.
  
  
  OBJECTIVE
  The authors sought to determine the effectiveness of the tarsal sling technique in preventing lower eyelid malposition.
  
  
  METHODS
  A retrospective analysis of 40 consecutive patients was conducted. Twenty patients underwent standard blepharoplasty (group 1), and 20 underwent blepharoplasty plus tarsal sling support (group 2). Pre- and postsurgical positions of the lower eyelid margin were compared by quantitative analysis of measurements obtained from clinical photographs.
  
  
  RESULTS
  Postoperatively, reduction of scleral appearance was noted for group 2. Although progressive recovery occurred in this group by 2 years postoperative, the lower eyelids did not revert to presurgical position, and a slight degree of overcorrection remained. The overcorrection was minimal, without unpleasant consequences for the patients. In contrast, group 1 patients experienced an increase in the distance between the interpupillary line and the lateral aspect of the lower eyelid margin after blepharoplasty. Although progressive resolution of scleral show occurred by 2 years postoperative, recovery was not complete.
  
  
  CONCLUSIONS
  Through quantitative analysis, the authors demonstrated the effectiveness of a simplified canthopexy procedure. Tarsal sling is an easy, quick, and efficacious procedure to prevent eyelid malposition after lower blepharoplasty.
authors.affiliation: Dr Pascali is a Specialist in Plastic Surgery and a consultant, Dr Brinci is a resident, and Dr Cervelli is a Specialist in Plastic Surgery, Full Professor, and Head of the Department of Plastic and Reconstructive Surgery at the University of Rome Tor Vergata, Rome, Italy. Dr Avantaggiato is a Specialist in Ear, Nose, and Throat Surgery and a consultant, and Dr Carinci is a Specialist in Maxillofacial Surgery and Full Professor in the Department of Morphology, Surgery and Experimental Medicine at the University of Ferrara, Ferrara, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Pascali
authors.affiliation: Dr Pascali is a Specialist in Plastic Surgery and a consultant, Dr Brinci is a resident, and Dr Cervelli is a Specialist in Plastic Surgery, Full Professor, and Head of the Department of Plastic and Reconstructive Surgery at the University of Rome Tor Vergata, Rome, Italy. Dr Avantaggiato is a Specialist in Ear, Nose, and Throat Surgery and a consultant, and Dr Carinci is a Specialist in Maxillofacial Surgery and Full Professor in the Department of Morphology, Surgery and Experimental Medicine at the University of Ferrara, Ferrara, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Avantaggiato
authors.affiliation: Dr Pascali is a Specialist in Plastic Surgery and a consultant, Dr Brinci is a resident, and Dr Cervelli is a Specialist in Plastic Surgery, Full Professor, and Head of the Department of Plastic and Reconstructive Surgery at the University of Rome Tor Vergata, Rome, Italy. Dr Avantaggiato is a Specialist in Ear, Nose, and Throat Surgery and a consultant, and Dr Carinci is a Specialist in Maxillofacial Surgery and Full Professor in the Department of Morphology, Surgery and Experimental Medicine at the University of Ferrara, Ferrara, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Brinci
authors.affiliation: Dr Pascali is a Specialist in Plastic Surgery and a consultant, Dr Brinci is a resident, and Dr Cervelli is a Specialist in Plastic Surgery, Full Professor, and Head of the Department of Plastic and Reconstructive Surgery at the University of Rome Tor Vergata, Rome, Italy. Dr Avantaggiato is a Specialist in Ear, Nose, and Throat Surgery and a consultant, and Dr Carinci is a Specialist in Maxillofacial Surgery and Full Professor in the Department of Morphology, Surgery and Experimental Medicine at the University of Ferrara, Ferrara, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Cervelli
authors.affiliation: Dr Pascali is a Specialist in Plastic Surgery and a consultant, Dr Brinci is a resident, and Dr Cervelli is a Specialist in Plastic Surgery, Full Professor, and Head of the Department of Plastic and Reconstructive Surgery at the University of Rome Tor Vergata, Rome, Italy. Dr Avantaggiato is a Specialist in Ear, Nose, and Throat Surgery and a consultant, and Dr Carinci is a Specialist in Maxillofacial Surgery and Full Professor in the Department of Morphology, Surgery and Experimental Medicine at the University of Ferrara, Ferrara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carinci
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D012060:Rejuvenation; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome