PURPOSE: Many techniques have been described for lateral canthopexy. The purpose of this study is to describe a technical modification of lateral canthopexy that involves percutaneous placement of a canthopexy suture through the confluence of the lateral superior and inferior grey lines or lateral canthal angle.

METHOD: A retrospective review was conducted from 2006 to 2008 of patients from the senior author’s office who underwent cosmetic upper blepharoplasty and lower lid blepharoplasty with canthopexy. Lower blepharoplasty was performed through a transconjunctival incision with redraping of the orbital fat. Patient sex, age, operation date, follow-up, and complication rate were recorded.             An upper blepharoplasty is completed but the lateral extent of the incision is not closed or, in the case in which upper blepharoplasty is not performed, a small incision is made in the upper eyelid crease laterally. An eighteen gauge needle is used to create a puncture wound at the confluence of the superior and inferior grey lines at the lateral commissure of the eye. One arm of a double-armed suture is placed through the puncture wound capturing the lateral retinaculum, and directed into the upper blepharoplasty incision, deep to the orbicularis oculi muscle. The second arm is subsequently placed through the same puncture wound, but on a slightly different path into the upper lid incision. These two sutures are secured to the periosteum on the undersurface of the superolateral orbital rim at a level just above the pupil, thus tightening the tarso-ligamentous sling. The suture is tied and tension of the lower lid is checked. A video presentation illustrates this technique.

RESULTS: A total of 52 canthopexies in 26 patients was performed. There were 25 females and 1 male. The average age of patients was 54.6 years. The average follow-up was 1 to 26 months with an average follow-up of 10 months. Three patients or 6 lower lids had early slight lower lid malposition which resolved at one month after conservative measures. Two patients had slight lower lid malpositioning on one side at one year follow-up. No patients required reoperation and there were no infections or hematomas. All patients were pleased with their final results.

CONCLUSION: Our lateral canthopexy modification is a minimally invasive technique that is simple to perform, with absolute assurance of capturing the lateral canthal tendon.