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In young adults with normal skeletal morphology the palpebral fissure is long and narrow. Distortions of, or deviations from, this shape may be secondary to heredity, aging, paralysis, trauma or previous surgery. With aging, descent of the lower lid and medial migration of the lateral canthus rounds the shape of the palpebral fissure. Standard blepharoplasty techniques which remove lower lid skin (and often muscle) tend to lower the lower lid margin further rounding the palpebral fissure. Canthoplasty procedures, by design, alter the shape of the palpebral fissure since they disassemble and reassemble the lateral canthus while shortening the lower lid margin.
Lateral canthopexy, since it does not violate the lid margin, maintains, or has the potential to restore, palpebral fissure shape including the lateral canthal angle.
Lateral canthopexy, the surgical repositioning of the lateral canthus is fundamental to altering or restoring the shape of the palpebral fissure as demonstrated in the patient example section. Depending on the clinical situation, lateral canthopexy may be performed as an isolated procedure, or more commonly together with midface elevation.
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