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The aesthetic anatomy of lower eyelid is detailed leading to discussion of operative technique to achieve the goals of blepharoplasty; for the lower lid these are a youthful lid cheek junction, a positive canthal tilt and no scleral show. The authors’ blepharoplasty technique, treating 104 patients over a five-year period, is explained in a detailed five-step approach focusing on lateral canthal suspension to optimise the position of the lower lid and prevent ectropian, all through the upper blepharoplasty incision. The steps highlighted are the five-step lateral canthopexy technique is as follows: (1) upper lateral eyelid incision, (2) creation of suborbicularis window, (3) placement of suborbicularis loop suture through superficial lateral retinaculum, (4) superior placement of suture to orbital rim periosteum, and (5) overcorrection by 1-2mm. There is a video to accompany the paper which enhances the understanding of the technical steps. This article would benefit from the inclusion of lower lid blepharoplasty technique as lateral canthal adjustment is a regularly performed and integral part of this procedure. Nevertheless, the paper provides a useful guide to improving lower lid position with a minimally invasive technique as an adjunct to optimise the aesthetic outcomes of blepharoplasty. 

Preventing lateral canthal malposition in modern blepharoplasty.
Rohrich RJ, Mohan R.
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James ET Wokes

University Hospital North Durham, UK

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