Adjunctive transcanthotomy lateral suborbicularis fat lift and orbitomalar ligament resuspension in lower eyelid ectropion repair

Purpose: Severe or recurrent lower eyelid ectropion can be challenging to correct. Studies on the role of upper midface ptosis in lower eyelid malposition have been published. The authors describe their technique of supporting the lateral cheek by lifting and reestablishing support for the orbitomalar ligament through a 10-mm canthotomy incision as an adjunct to a lateral tarsal strip procedure. In many cases, this technique allows the eyelid to be properly repositioned without skin grafting. Methods: A retrospective chart review of patients with severe multifactorial or recurrent lower eyelid ectropion. A preperiosteal dissection over the malar eminence and resuspension of the lateral aspect of the suborbicularis oculi fat was performed through a 10-mm lateral canthotomy at the time of lateral tarsal strip procedure. The longest follow-up was 20 months, with an average of 7.8 months postoperatively. Postoperative eyelid position and patient symptoms were used as outcome measures. Results: Twelve patients underwent repair of severe ectropion with a lateral tarsal strip procedure and adjunctive transcanthotomy lateral suborbicularis oculi fat lift with orbitomalar ligament resuspension. In 3 cases of severe paralytic ectropion and in 1 patient with poor healing, a small lateral tarsorrhaphy was also performed. The patients achieved excellent improvement in lower eyelid position, with resolution of symptoms and satisfactory aesthetic outcomes. Conclusions: Elevating the lateral suborbicularis oculi fat by resuspending the orbitomalar ligament was effective in supporting the lateral cheek. This resulted in recruitment of anterior lamella and allowed for good lower eyelid repositioning. The extent of dissection could be graded to achieve the desired surgical objectives. More invasive surgery such as full-thickness skin grafting was avoided. This technique can be a relatively noninvasive, yet powerful adjunct in the treatment of severe or recurrent lower eyelid ectropion.