As in Figure 8, when eyes appear close-set due to the bone structure, enlarging the lateral scleral triangle though lateral canthoplasty can make the eyes appear more close-set.

 

Surgical Techniques of Medial Canthoplasty and Lateral Canthoplasty

 

Briefly, surgical techniques of medial canthoplasty include the Mustarde method, Mulliken method, Modified Uchida method, and Park’s Z-plasty method, etc. In the past, moving the skin using simple incision, V-Y advancement flap, Z-technique, and W-technique were used. Recently, Skin redraping method is commonly used and I also mainly use this technique (Figure 9).

 

Figure 9. Skin redraping method. Dissecting and pulling downward the area marked with a dotted line (left Figure) results in redraping (right Figure )(Arch Aesthetic Plast Surg 2014;20(3):129-139). 

 

Lateral canthoplasty can use the Von-ammon method, Fox method, Uchida method, and Shin method, etc. They generally are Y-V flap, W-flap, or half Z-flap techniques.

 

HELIOSⅡ/LOTUSⅡ/HYPERION – Manufacturer: LASEROPTEK(www.laseroptek.com)

 

Lowering of the lower eyelid and Surgical Techniques

Lateral canthoplasty is limited to the size of the orbit and brings little improvement in patients with narrow orbits. Ideally, the bottom of the iris should be touching the edge of the lower eyelid or covered by the lower eyelid by about 1 mm. If the lower eyelid covers the iris more than this, ptosis correction will not bring sufficient improvement. This is when lowering of the lower eyelid can be beneficial (Figure 10).

 

Figure 10. Lowering of the lower eyelid can be carried out to lower the the boundary of the lower eyelid and increase the palpebral fissure. 

Lowering of the lower eyelid can be carried out using either incisional or non-incisional methods. The non-incisional method is similar to those used in non-incisional corrective blepharoplasty which we discussed in the previous article. In the incisional method, the lower eyelid flap can be pulled and anchored to the capsulopalpebral fascia which is the lower eyelid retractor.

 

-To be continued