Canthoplasty is a specialized surgical procedure focused on reshaping the canthus, the corner of the eye where the upper and lower eyelids meet. It serves both aesthetic and functional purposes. Aesthetically, it is often sought to change the eye’s shape, creating a more elongated or “almond-shaped” appearance. The procedure also addresses medical conditions, such as lower eyelid laxity or droopiness, which can impair vision or cause discomfort. By adjusting the supporting structures of the eyelid, canthoplasty offers a permanent alteration to the eye’s contour.
Defining Canthoplasty: Purpose and Types
The canthus is a complex anatomical structure composed of tendons and ligaments that hold the eyelids taut against the eyeball. Canthoplasty procedures are generally categorized based on the specific corner of the eye being addressed.
Lateral Canthoplasty
Lateral canthoplasty focuses on the outer corner of the eye. It is often performed to lift a drooping outer angle, lengthen the eye horizontally, or achieve a desirable upward slant, sometimes referred to as a “positive canthal tilt.”
Medial Canthoplasty
Conversely, medial canthoplasty, sometimes called epicanthoplasty, targets the inner corner near the nose. This procedure is typically performed to remove the epicanthal fold, a skin fold that covers the inner corner. This exposes more of the eye, making the eyes appear larger and farther apart. The goal of both types is to improve the overall harmony and balance of the eyes.
Canthoplasty is often confused with canthopexy, but they differ significantly in their approach and invasiveness. Canthopexy is a less invasive procedure that uses sutures to tighten and stabilize the existing canthal tendon without detaching it from the bone. Canthoplasty is a more extensive reconstructive procedure, involving the cutting, detachment, and repositioning of the canthal tendon to achieve a more dramatic change in shape or position. Canthoplasty is usually necessary for significant cosmetic reshaping or for correcting severe lower eyelid laxity.
The Surgical Procedure
Canthoplasty is typically performed as an outpatient procedure using local anesthesia combined with intravenous sedation, though general anesthesia may be an option depending on the complexity. The surgeon begins by making a small, precise incision, strategically placed in the natural crease or fold of the eyelid to minimize visible scarring. For lateral canthoplasty, this incision is made near the outer corner of the eye.
The surgeon carefully accesses the lateral canthal tendon, which anchors the eyelid to the orbital bone. To reshape the eye, this tendon is detached from the bone. The detached strip of tissue is then shortened, tightened, and repositioned to the desired height and tension.
The newly formed tendon strip is then securely re-anchored to the periosteum, the dense layer of connective tissue covering the lateral orbital rim bone. This reattachment permanently establishes the new shape and support for the lower eyelid. Finally, the small incision is closed using fine sutures, which are generally removed within the first week following the procedure.
Recovery and Post-Operative Care
Following the procedure, patients can expect immediate symptoms such as swelling, bruising, and a sensation of tightness around the treated area. These temporary effects are typically most prominent during the first two to three days. Mild discomfort is common during this period and can be managed effectively with prescribed or over-the-counter pain medication.
Initial post-operative care is concentrated on reducing swelling and protecting the surgical site. Patients are advised to apply cold compresses frequently for the first 48 to 72 hours and should sleep with their head elevated to help minimize fluid retention and bruising. The surgeon will also prescribe specific antibiotic ointments or eye drops for application to the incision site to prevent infection.
Sutures are generally removed between five and seven days after the operation. Patients can typically return to work and light, non-strenuous daily activities within one week to ten days. However, more vigorous activities, heavy lifting, and anything that significantly increases blood pressure must be avoided for at least two to three weeks to prevent complications.
It is also important to refrain from rubbing the eyes and to avoid wearing contact lenses for the first two weeks post-surgery. While the majority of the swelling and bruising will subside within the first month, the final, stable aesthetic result typically emerges several months following the surgery, as all residual internal swelling completely resolves.
Potential Risks and Long-Term Results
As with any surgical procedure, canthoplasty carries risks, and patients should be aware of potential complications. These include the possibility of infection, bleeding, and scarring, though the strategic placement of incisions is designed to keep scars minimal and well-hidden. A more specific concern is the risk of asymmetry between the two eyes, or the possibility of an overcorrection or undercorrection that may affect the desired aesthetic outcome.
Temporary side effects like dry eye, excessive tearing, or sensitivity to light are sometimes reported during the initial recovery phase. In rare instances, patients may experience complications such as lid retraction, where the eyelid margin is pulled down too far, or difficulty fully closing the eyes. Choosing a highly experienced oculoplastic surgeon helps to mitigate these potential issues.
The results of a canthoplasty are considered long-lasting and generally permanent because the procedure involves surgically altering and re-anchoring the structural tendons of the eye. While the natural aging process will continue to affect the surrounding skin and tissues over time, the fundamental changes to the eye shape and eyelid support achieved by the surgery are maintained. The final, permanent appearance is usually visible three to six months after the operation when all swelling has completely dissipated.