Tarsal Sling: An Essential Stitch to Prevent Scleral Show in Lower Blepharoplasty.

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Michele Pascali, MD Anna Avantaggiato, MD Lorenzo Brinci, MD Valerio Cervelli, MDFrancesco Carinci, MD

Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 11–19

Published:  07 January 2015


Despite its popularity for facial rejuvenation, blepharoplasty has been associated with several adverse effects. One of the most common is eyelid displacement after lower transcutaneous blepharoplasty. The tarsal slingprocedure affixes the external portion of the septum (the lateral canthal ligament) to the internal orbital wall periosteum with a simple suture. This simplified canthopexy decreases the risk of lower eyelid margin displacement.


The authors sought to determine the effectiveness of the tarsal slingtechnique in preventing lower eyelid malposition.


A retrospective analysis of 40 consecutive patients was conducted. Twenty patients underwent standard blepharoplasty (group 1), and 20 underwent blepharoplasty plus tarsal sling support (group 2). Pre- and postsurgical positions of the lower eyelid margin were compared by quantitative analysis of measurements obtained from clinical photographs.


Postoperatively, reduction of scleral appearance was noted for group 2. Although progressive recovery occurred in this group by 2 years postoperative, the lower eyelids did not revert to presurgical position, and a slight degree of overcorrection remained. The overcorrection was minimal, without unpleasant consequences for the patients. In contrast, group 1 patients experienced an increase in the distance between the interpupillary line and the lateral aspect of the lower eyelid margin after blepharoplasty. Although progressive resolution of scleral show occurred by 2 years postoperative, recovery was not complete.


Through quantitative analysis, the authors demonstrated the effectiveness of a simplified canthopexy procedure. Tarsal sling is an easy, quick, and efficacious procedure to prevent eyelid malposition after lower blepharoplasty.

Level of Evidence: 4