What Is Canthoplasty?

Medically Reviewed by Poonam Sachdev on August 24, 2022
Written by Sarah Vallie
5 min read

If you’ve noticed the skin of your eyelids drooping with age or have a medical condition that causes saggy eyelids, you may wonder if there’s any way to tighten your eyelids and restore your vision. One common method to tighten saggy eyelids is a canthoplasty.

Canthoplasty is a cosmetic procedure that reconstructs the eyelid. It’s sometimes referred to as “almond eye” surgery because it gives the eyes a more almond shape.

Canthoplasty procedures tighten saggy eyelids, creating a more open eye and enhancing vision. The most common reasons people request canthoplasty procedures are:

  • To change and adjust the shape of the eye
  • To look younger, as this procedure repairs drooping eyelids
  • To brighten the eyes

Canthoplasties may also relieve some medical issues. For example, if an eyelid is too lax, it may not close properly. This can damage the film of the eye or exposure keratopathy, a condition in which the cornea becomes damaged due to prolonged exposure to the environment.

Primary candidates for canthoplasties are people who have lower eyelid malpositioning. This refers to sagging, bagginess, or drooping of the lower eyelid. This can occur due to aging or due to a medical condition.

Aside from conditions like eyelid malpositioning and eyelid laxity, a few common conditions can make someone a good candidate for canthoplasty:

Ectropion. Ectropion is a condition in which the eyelid turns outward, leaving the inner eyelid exposed. It more commonly occurs in the lower eyelid. The most common cause of ectropion is muscle weakness due to aging, but it can also be caused by facial paralysis, eyelid growths, skin that has been scarred or damaged from surgery or trauma, and some genetic conditions such as Down syndrome. 

Entropion. The opposite of ectropion, entropion is a condition in which the eyelid turns inward, causing your eyelashes and skin to rub up against the surface of your eye. Entropion has many of the same causes as ectropion, such as muscle weakness and scarring or damage. Other causes include inflammation, a developmental condition, and an eye infection called trachoma. Trachoma is a bacterial infection of the eye common in many of the globe’s poorest areas and can lead to blindness.

Paralytic lagophthalmos. Paralytic lagophthalmos is a condition in which the patient cannot close their eyes all the way due to facial paralysis. This facial paralysis is due to loss of function of the seventh cranial nerve. This loss of function can be due to many things, such as Bell’s Palsy, Moebius syndrome, tumors, trauma, and diseases including Lyme disease, leprosy, chicken pox, polio, Guillain-Barre syndrome, and more.

Canthoplasties are performed by oculoplastic surgeons. Oculoplastic surgeons are ophthalmologists with a specialty in plastic surgery or reconstructive surgery of the area around the eyes, as well as the tear system.

Your surgeon will likely give you a list of guidelines to follow to ensure your surgery goes smoothly. They may tell you to:

  • Stop wearing contact lenses four weeks before surgery.
  • Don’t use any topical treatments on your face, including on the day before surgery.
  • Thoroughly wash the area around your eyes before surgery.
  • Ensure you have transportation home after the procedure.
  • Ensure you have someone to help you at home for a few hours after you return from surgery.

The procedure for a canthoplasty takes one to three hours. You will either be given local anesthesia or placed under general anesthesia. Once you are numb or anesthetized, the oculoplastic surgeon will make a small incision near your bottom eyelid. To tighten the eyelid, the oculoplastic surgeon will remove any excess skin, fat, and muscle. 

Once the surgeon is satisfied, they will close the incision up with stitches.

Recovery from a canthoplasty is usually not too strenuous. To keep your surgery site healthy, keep the following post-op tips in mind:

  • Have someone at home to help you for at least the first 48 hours after your surgery.
  • Take prescribed medications as advised.
  • Report any medication side effects, like nausea or allergic reactions.
  • Increased pain, increased redness around the incision, and fever should be viewed as an emergency. Contact your doctor right away or go to the emergency room.
  • Attend a follow-up appointment, usually at the two-week mark, so a nurse can check your incision and answer any questions.
  • Avoid strenuous activities for at least six weeks after surgery.
  • Use SPF 30 or higher for the first six months after surgery, as your incisions will be sensitive to sunlight.

No surgery is without risks. Your oculoplastic surgeon should make sure you understand all the potential risks and complications of canthoplasty before you have the surgery done. 

Common risks associated with the canthoplasty procedure include:

  • Infection if the sutures are not properly cared for
  • Painful recovery
  • Bleeding in patients who have hemorrhagic conditions
  • Sensitivity to light
  • Dry eye
  • Ectropion
  • In some cases, recurrence of the droopy eyelid
  • Asymmetrical eyes
  • If the procedure is done while you’re young, the incision may need to be touched up as you age and your skin becomes less elastic.

Some complications of canthoplasty include:

  • Failure to correct the problem
  • Stitches falling out
  • Swelling around the stitches
  • Problems with tear duct function
  • Lid retraction
  • Diplopia (double vision)
  • Rarely, the patient may experience facial nerve palsy resulting in weakness or paralysis in the face

Whether you’re choosing a canthoplasty for medical reasons or cosmetic ones, you’ll need to find an oculoplastic surgeon. To ensure the best outcome, be sure to properly research your options. 

Look at things like:

  • Board certification. Your oculoplastic surgeon should be board-certified by either the American Board or Ophthalmology or the American Board of Surgery. Surgeons with specific eyelid surgery training may also be members of the American Society of Oculofacial Plastic and Reconstructive Surgery.
  • Read reviews. The best way to get an unbiased look at a surgeon’s skill and temperament is often through independent reviews on Google, Yelp, and healthcare provider review sites.
  • Schedule a consultation. Scheduling a consultation doesn’t mean you’re obligated to go with that surgeon. It’s a test run that allows you to get to know that surgeon and view their portfolio.

Check with your insurance to find out what they’ll cover. Most insurance is unlikely to cover the procedure for purely cosmetic reasons and may not cover it for medical ones either.

Be sure you understand both the benefits and risks associated with a canthoplasty so you’re able to make the best decision.