The KS-Pexy: A Novel Method to Manage Horizontal Lower Eyelid Laxity.

Background: Patients with horizontal lower lid laxity undergoing lower lid blepharoplasty are at a high risk for lid malposition. Prophylactic correction of horizontal lower lid laxity during blepharoplasty may alleviate this risk. In this article, the authors describe a novel lower lid blepharoplasty technique, the KS-pexy (named after its originators, Kuhnt and Szymanowski), for correcting horizontal lower lid laxity.

Methods: All cases of KS-pexy between September of 2009 and June of 2018 from an aesthetic practice were reviewed retrospectively. All patients were diagnosed with horizontal lower lid laxity and requested lower lid blepharoplasty for aesthetic concerns. Patient demographics, clinical presentation, procedure details, and intraoperative findings were analyzed.

Results: Sixty-two patients underwent KS-pexy performed by the senior author. The average follow-up was 41.1 months, ranging from 2 to 107 months. Thirteen patients had a negative vector, 54 patients received a KS-pexy in combination with another facial procedure, and 14 patients had their KS-pexy as a secondary procedure. The overall success rate was 96.8 percent. The complication profile was as follows: chemosis (27.4 percent), new-onset dry eyes persisting longer than 8 weeks (6.5 percent), temporary lower eyelid malposition (4.8 percent), lower eyelid malposition requiring surgical intervention (3.2 percent), poor scar quality (1.6 percent), lower lid abscess (1.6 percent), transient conjunctivitis (1.6 percent), lateral fat compartment swelling (1.6 percent), canthopexy dehiscence (1.6 percent), hordeolum (1.6 percent), and temporary V2 paresthesia (1.6 percent).

Conclusion: The KS-pexy is an effective means to treat horizontal eyelid laxity prophylactically in patients requesting lower eyelid blepharoplasty for aesthetic reasons.

Clinical Question/level Of Evidence: Therapeutic, IV.