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J Plast Reconstr Aesthet Surg. 2013 May;66(5):675-81. doi: 10.1016/j.bjps.2012.12.028. Epub 2013 Feb 13.

Bridge of bone canthopexy: technique and morphologic assessment.

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Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA.



Malposition of the lower eyelid may disrupt facial aesthetics and impair proper eyelid function. Multiple techniques have been proposed to restore lower eyelid position. The purpose of this study is to report on a modified bridge of bone canthopexy technique and assess its effect on lower eyelid and palpebral fissure restoration.


A retrospective chart review was conducted. Pre- and post-operative photographs of patients were evaluated by a blinded observer. Pair-wise and chi-square tests were conducted with an observed p-value of 0.05 or less considered statistically significant.


12 patients (7 females) with a mean age of 42 (range = 7-87) were included. Canthal tilt and scleral show decreased significantly following surgery (p = 0.05), and the eye fissure index and inferior coverage of the iris approached significance (p = 0.16 and p = 0.07, respectively). Two minor complications were encountered in our series.


The modified bridge of bone canthopexy is a safe and effective technique for alteration of the lower eyelid and is broadly applicable to all causes of negative canthal angulation. Further studies are necessary to test the longevity and stability of this procedure.

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