How I do it: lateral canthal web revision—single Z-plasty technique

Upper eyelid blepharoplasty is a surgical procedure in which excess skin, fat, and/or muscle are removed from the upper eyelid to correct lid redundancy. The term was first coined in 1818 by Karl Ferdinand Von Graefe, who used the technique to reconstruct the eyelid post-cancer resection [1]. Since then, blepharoplasty has become one of the most commonly performed procedures in cosmetic surgery in the United States [2]. Blepharoplasty can be performed for both aesthetic and functional reasons. Vision impairment secondary to dermatochalasis, epiblepharon with lash ptosis, severe blepharochalasis, inflammatory disorders (Grave’s Disease), or eyelid trauma are the most common functional indications for blepharoplasty [3, 4]. Cosmetic indications include eyelid fullness, and eyelid asymmetry [5].

Overall, most patients are satisfied with the appearance of their eyelids post-blepharoplasty, but, as with all surgical procedures, it is not without risk of complication. Lid asymmetry, lagophthalmos, lacrimal duct injury, hematoma formation, medial canthal webbing, and wound dehiscence are all potential complications [5]. A less reported complication is lateral canthal webbing. A lateral canthal web occurs when the lateral aspect of the upper blepharoplasty incision is taken below the equator of the lateral canthus. It can also occur if excessive eyelid skin is removed laterally. During healing, scar contracture pulls the lax lower lateral eyelid skin superior and upper eyelid skin inferior, thus causing skin bridging across the lateral canthus (Fig. 1).

Fig. 1figure 1

Simple excision of the lateral canthal web will not improve the skin bridge, and often makes it much worse. The senior surgeon (CM) has received many patient referrals for blepharoplasty revision, secondary to lateral canthal webbing. The purpose of this paper is to share our experience using our single Z-plasty technique for correcting this avoidable complication.

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