title: Lateral Canthal Support in Prevention of Lower Eyelid Malpositioning in Blepharoplasty: The Tarsal Sling.
abstract: Lower blepharoplasty is a cornerstone in facial rejuvenation and improvement. Despite its popularity, several adverse effects have been described; of these, postsurgical eyelid displacement, with its aesthetic and functional consequences, is one of the more frequent complications. The tarsal sling procedure is a simplified canthopexy consisting in the fixation of the lateral portion of the septum--the canthal ligament--to the orbital wall periosteum. The aim of the current research is to demonstrate how the tarsal sling technique is effective in the prevention of lower lid malpositioning. A retrospective analysis of 40 consecutive healthy individuals was carried out. In group 1, 20 patients underwent standard blepharoplasty; in group 2, blepharoplasty was associated to the tarsal sling canthopexy. Pre- and postsurgical position of the lower eyelid margin was compared through photographic measurements at 5 time points and statistical analysis performed. Group 1 patients evidenced an increased distance between the interpupillary line and the lateral aspect of the lower lid margin. A progressive spontaneous improvement (reduction in scleral exposition) was detected. Patients who underwent the tarsal sling procedure (group 2) reported a postoperative overcorrection of scleral appearance. Two years postsurgery, progressive relapse occurred, but the lower eyelid did not reach presurgical values and maintained a slight degree of overcorrection. Tarsal sling is an easy, fast, and efficacious procedure to prevent eyelid displacement in lower blepharoplasty. Its routine use is a tool to assure further support to lower lids in the younger patients or when lid laxity is absent during presurgical examination.
authors.affiliation: *Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome †Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pascali
authors.forename: A
authors.initials: A
authors.lastname: Avantaggiato
authors.forename: L
authors.initials: L
authors.lastname: Brinci
authors.forename: V
authors.initials: V
authors.lastname: Cervelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Carinci
mesh_terms: D019882:Blepharoplasty / Q000009:adverse effects*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D010521:Periosteum / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D019736:Prostheses and Implants; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*