This is Richard Allen at the University of Iowa. This video demonstrates a transblepharoplasty canthopexy. The patient has had a previous excision of skin and orbicularis muscle for the blepharoplasty. Dissection is carried out between the orbicularis muscle and the orbital septum to expose the superior lateral portion of the orbital rim. A 4-0 prolene suture is then used. The larger needle of the suture is introduced through the incision and exits at the level of the meibomian gland orifices of the lateral lower lid. The needle is then placed adjacent to the exit wound and directed posteriorly to engage the periosteum of the superior lateral orbital rim. The needle can often be visualized through the blepharoplasty incision and then backed up to feel the orbital rim. The needle is then advanced to engage the periosteum. The needle is then grasped, and the tightening effect of the canthopexy is demonstrated by pulling on the suture. The suture is then tied. The blepharoplasty incision can then be closed. I think that this procedure is particularly useful in those patients undergoing upper lid surgery who would benefit from lower lid tightening but do not need as extensive of a surgery as a lateral tarsal strip.