Canthoplasty (for sagging eyes)

What’s the difference between a Canthoplasty and a Blepharoplasty?

Canthoplasty surgery should not be confused with another type of eyelid surgery known as a lower lid blepharoplasty. A blepharoplasty is performed to make the eye appear younger by removing excess skin, muscle, and possibly fat from the lower or upper eyelid, but it does not modify the shape or size of the eye. In short, a blepharoplasty gets rid of “baggage.” ;)

In contrast, a canthoplasty is a plastic surgery procedure designed to lift the eye’s outer corner (the lateral canthus), reshape the eye to a more almond configuration, and enlarge the eye-opening. The net result is a brighter, bigger, more awake-looking eye.

Why do people undergo canthoplasty?

 People consider undergoing canthoplasties for a number of reasons:

• Drooping or sagging lower eyelids (known as ectropion) -- with age, the skin and tendons around our eyes can lose elasticity, resulting in drooping or laxity of the lower eyelids, creating a tired or sad appearance
• Eye trauma resulting in lower eyelid laxity or lower eyelid retraction may necessitate a canthoplasty to correct the malposition of the outer corner of the eye 
• Dissatisfaction with a prior surgical outcome -- some canthoplasties are performed as a revisional surgery to correct lower lid complications resulting from prior surgery, such as lower lid sagging or eversion deformities that reveal too much white of the eye (scleral show)
•  Some patients seek out canthoplasty surgery to achieve a more almond-shaped eye by uplifting a downward slanting eyelid and increasing the horizontal length of the eye

What happens during a canthoplasty surgery?

During your initial consultation, your surgeon will examine your eye shape and function carefully and talk with you at length about what you wish to accomplish with your surgery. After you both have agreed that a canthoplasty is an appropriate choice, your doctor will design the desired eye shape based on your eyes’ shape, proportion, and symmetry.

Your surgery will be performed on an outpatient basis using local anesthesia and, if necessary, IV sedation. The procedure typically takes from one to two hours and involves cutting the lower canthal tendon and repositioning or tightening it. An incision is usually made within the natural crease at the eyelid’s outer corner to minimize visible scarring. The tendon is then pulled to elevate the location of where the upper and lower eyelids meet and is then reattached using stitches.

After the surgery is done, a temporary protective shield is placed over your eyes.

Recovering from canthoplasty

Upon awakening after your surgery, if you remove your protective eye shields, you will notice that your vision is blurred. This is due to an antibiotic ointment that is applied to your eyes to prevent them from drying out during surgery. You’ll be sent home with this ointment with instructions to apply it several times per day inside your eye and on your incision to prevent infection.  

You will be instructed to bring someone with you to drive you home from surgery. It’s advisable to have someone stay with you for the first day or two after surgery, as you will be most comfortable keeping your eyes closed and covered with protective eye shields.

Recovery after a canthoplasty is similar to other eyelid surgery: it typically takes from two to three weeks. Most patients experience swelling and bruising that decrease to a great extent over the first two weeks but may take several more weeks to fully resolve. The final results will become apparent after a few months.

Following your doctor’s post-op instructions is particularly important during this time to avoid complications and scarring of the delicate soft tissue surrounding your eyes. You may be prescribed ointments or eye drops to prevent infection, in addition to artificial tears. Steroid drops might be necessary to address eye swelling. 

Recovery may be slightly uncomfortable at first. Your doctor can prescribe pain medication in the event that it’s necessary. 

You will be advised to take showers and avoid splashing your face, as well as rubbing your eyes for at least one month after surgery. Strenuous exercise is to be avoided for at least two weeks or until your doctor sees you in follow-up and says it’s safe to do so. Makeup will be usually be permitted after two weeks. 

Are canthoplasty results permanent?

Canthoplasties require a very high level of skill and experience to be performed well. When done by a very experienced board-certified oculoplastics surgeon like Dr. Israel, the results of a canthoplasty procedure are considered a permanent solution for eyelid malposition, and revision surgeries are rarely necessary. 

Are there any risks or complications from a canthoplasty?

Of course, every surgery involves risk however serious complications from a canthoplasty are extremely rare. Swelling and bruising are common during the first few weeks post-op and this usually resolves for the most part within two to three weeks. You may also experience dry eyes, excess tearing, and blurred vision during the first few weeks after surgery. 

Your surgeon will review all possible risks and complications of your surgical procedure in detail during your pre-operative consultation. You will also receive this information in writing so that you can review it as part of the consent process

Why Choose AGEI for your eyelid surgery?

Your eyes are one of the most delicate structures in your body. That’s why, when you’re looking for a Los Angeles area surgeon to correct the appearance or function of your eyelids and the structures surrounding your eyes, you want to seek out an oculoplastics surgeon.

In contrast to a plastic surgeon, an oculoplastics surgeon is an ophthalmologist with extensive training in microsurgical eye surgery followed by highly specialized training in ophthalmic plastic and reconstructive surgery. The health and safety of your eyes are the number one priority in all surgical planning performed by an oculoplastics surgeon.

As a trained ophthalmologist, Dr. Rafi Israel is able to thoroughly examine your eye, understand any underlying eye disease, and identify potential complications or eye problems that might impact the surgical plan -- things that a plastic surgeon is simply not trained to do.

We have extensive experience in treating functional eye problems affecting patients’ vision and eye health, performing cosmetic procedures, and doing revisions of surgeries performed elsewhere that have gone bad.

Among the conditions we treat are excess eyelid skin or fat, drooping eyelids, wrinkles around the eyes, eyelid reconstruction after tumor removal, excessive tearing, revising prior unsatisfactory eyelid surgeries, abnormally turned in (entropion) or turned out (ectropion) lid margins, and traumatic eye injuries.

If you would like to schedule a consultation with Dr. Israel in our Beverly Hills office to discuss your concerns about the appearance or function of your eyelids and to learn what treatments might be right for you, please call 866-945-2745 or click here to request an appointment online.

Our ophthalmology clinics' Covid-19 patient safety procedures exceed all CDC recommendations.