The lower-eyelid tarsal-strip procedure.
The first step is to mark a 1-cm incision along a natural wrinkle line in the lateral canthal area. The marked area is infiltrated with 1% lidocaine in 1:100,000 epinephrine. Sharp scissors are used to cut through the orbicularis oculi all the way down to the lateral orbital rim. The anterior lamellar flap (skin and muscle) is dissected inferiorly and off the lateral aspect of the inferior canthal tendon (figure 1, A). Next, the conjunctiva is dissected from the inferior canthal tendon, and an inferior cantholysis is performed. The lower canthal tendon is stretched to the orbital rim so that the surgeon can estimate the amount of shortening required for proper lid tension (figure 1, B). The gray line is removed, and the flap of excess skin and muscle is trimmed. The lower canthal tendon is then suspended to the periosteum over Whitnall's tubercle with a 4-0 polydioxanone or 4-0 Mersilene suture (figure 1, C). The skin of the lateral canthus is then reapproximated with a running 6-0 fast-absorbing gut suture.
[FIGURE 1 OMITTED]
In the case illustrated in this article, the final cosmetic results are good (figure 2).
[FIGURE 2 OMITTED]
Dana S. Smith, MD; Mark K. Wax, MD
From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland.
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|Title Annotation:||FACIAL PLASTIC SURGERY CLINIC|
|Author:||Wax, Mark K.|
|Publication:||Ear, Nose and Throat Journal|
|Article Type:||Brief Article|
|Date:||Nov 1, 2005|
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