Canthoplasty, often referred to as “cat-eye surgery” or “fox-eye surgery,” is a cosmetic and reconstructive surgical procedure that stabilizes the insertion of the outer corner of the eyelids, also known as the lateral canthus. The surgery has the power to tighten the lower eyelid and repositions it. Done well, this procedure can enhance the eye’s shape, creating a more almond or, when aesthetically helpful, an upturned appearance. It can also help correct issues such as sagging or drooping eyelids, which might occur due to aging, genetics, or previous surgeries. The power and success of surgery very much depends on the skill of the surgeon performing the procedure.
The procedure primarily involves altering the lateral canthal tendon, which is the structure that anchors the outer corner of the eyelid to the bone. By adjusting the position and tension of this tendon, the surgeon can achieve a more lifted and youthful appearance of the eyes. In many cases, the procedure contributes to a longer horizontal width of the eye helping it to be more almond shaped rather than more round. This reshaping can be both subtle and aesthetically very important in that it recaputres a youthful aspect of the eyes that can be lost with aging or as a consequence of prior eyelid surgery. Canthoplasty is a delicate surgery, typically performed by oculoplastic surgeons who specialize in procedures around the eyes. In most cases, the cosmetic effect of this surgery is subtle at best. Even in these circumstances it can be an essential structural component of reestablishing a less round and more almond eye shape or supporting the lower eyelid so it is less likely to be malpositioned after lower eyelid surgery.
Indications for Canthoplasty
Canthoplasty is considered for both functional and cosmetic reasons. The most common indications for this surgery include:
- Aesthetic Enhancement: Many individuals seek canthoplasty to achieve a more aesthetically pleasing eye shape. This may involve creating a more upturned eye, which is often associated with a youthful and exotic appearance. The trend for a “fox-eye” or “cat-eye” look has made this procedure popular in cosmetic surgery circles. Unfortunatley canthoplasty is not really appropriate to accomplish these changes. It can be used to subtlely change the lateral canthal angle. Overdone the effect not ideal. It requires a great deal of experience and judgement to know what can and can’t be aesthetically accomplished. A careful analysis of many celebrities and social media personalities show that their so-called “snatched” look is the result of over-aggressive midface surgery rather than a canthoplasty. Sadly, it is a fine line between looking improved and being disfigure by the more extreme forms of these midface/temple lifts. If you study enough before and after images you realize that many of these individuals have been disfigured and not enchanced by these procedures.
- Correcting Ectropion, Entropion, and Lower eyelid retraction: Ectropion is a condition where the lower eyelid droops away from the eye, exposing the inner surface and potentially causing irritation. Entropion, on the other hand, occurs when the eyelid turns inward, causing the lashes to rub against the eye, leading to discomfort and damage. Lower eyelid retraction occurs when the lower eyelid rests on the eye surface but it is does not cover and protect enough of the eye surface exposing the white sclera below the colored part of the eye, the limbus. Canthoplasty is used as a component in the correct of all of these conditions by tightening and repositioning the eyelid.
- Sagging or Drooping Eyelids (partial lateral canthal disinsertion): With age, the skin and muscles around the eyes may lose their elasticity, causing the eyelids to sag or droop. This can lead to a tired or sad appearance and may even interfere with vision in severe cases. Canthoplasty can address this issue by lifting and tightening the eyelid, restoring a more youthful look.
- Post-Surgical Complications: Some individuals may develop complications after previous eyelid surgeries (blepharoplasty), such as lower eyelid retraction or malposition. Canthoplasty may be performed as a corrective measure to restore proper eyelid positioning and function. All too commonly, Canthoplasty alone lacks sufficient power to restore the shape of the eye. Under those circumstances, canthoplasty with or without aggressive shortening of the lower eyelid is often disappointingly ineffective in the repair of these eyelid retractions even if the surgeon goes to the trouble to make a “drill hole” in the orbital rim bone. Dr. Steinsapir is often called upon to repair these types of failed “fixes.” Generally, these eyelids require the recruitment of cheek soft tissue and skin into the eyelid space. A rim implant is also placed to support the recruited cheek tissue and skin. In these situations, the inner layers of the lower eyelid are often damaged and scarred down by the original surgery. Tissue, called a hard palate graft, is borrowed from the roof of the mouth for the purpose of permanently expanding this contraction. Once these components are in place, the surgery is finished with carefully performed lateral cannthoplasty that repositioned the lateral canthal corner under no tension to recreate the position of a natural eyelid lateral canthus.
- Trauma Repair: In cases where the eye or eyelid has been injured, canthoplasty may be necessary to repair damage and restore the eye’s natural shape and function.
The Canthoplasty Procedure
Canthoplasty is usually performed under local anesthesia with sedation. Some surgeons make the mistake of performing these surgeries under general anesthesia. It is a mistake because it is necessary to be able to sit the patient up and have them open and close the eye during surgery. This allows the surgeon to assess the accuracy of the canthal placement. If it is not right, the surgeon will and must reposition the corner and reassess its position as many times as necessary to achieve the desired repositioning. Similarly, this is not a procedure to be done under just local anesthetic. Repositioning the lateral canthal angle is invasive and most patients are much more comfortable with intravenous sedation administered by an anesthesia provider. The procedure typically takes one to two hours, depending on the complexity and whether other procedures, such as blepharoplasty, are being performed simultaneously.
Here’s an overview of the steps involved:
- Incision: The surgeon makes a small incision at the outer corner of the eye, along the natural crease to minimize visible scarring. This is generally only 5 mm in length.
- Canthal adjustment: Depending on the precise indication for surgery, the canthoplasty is performed open or closed. The open canthoplasty is a more powerful procedure. The closed canthoplasty is less disruptive to the tissues but is also less powerful. The canthal tendon is carefully exposed, and the surgeon then tightens and repositions it to achieve the desired eyelid contour. In some cases, a small amount of skin or muscle may be removed to enhance the effect.
- Suturing: The tendon is securely anchored to the bone. The precisely placement is critical. The suture needs to assure that the inner aspect of the lower eyelid rides on the surface of the eye. There can be no gaps which will cause drying of the eye surface. In addition the position of the lateral canthus requires careful precision. Once positioning is accomplished, the incision is closed with fine sutures. These sutures are typically removed after about a week. The deep lateral canthal suture is a permanent suture.
- Recovery: After the procedure, the patient may experience swelling, bruising, and discomfort, which typically subside within a couple of weeks. Full recovery and the final result may take several months as the tissues settle into their new position.
Do You Need a Canthoplasty?
Deciding whether you need a canthoplasty involves careful consideration of your goals, the current state of your eyelids, and the potential risks and benefits of the surgery. Here are some factors to consider:
- Your Aesthetic Goals: If you’re seeking to change the shape of your eyes for cosmetic reasons, such as achieving a more upturned or elongated eye appearance, canthoplasty might be an option. However, it’s important to have realistic expectations and understand that the procedure’s results should enhance your natural features rather than completely alter them. In many cases it may not be immediately obvious that the lateral canthal angle is disinserted. The effect may be subtle. The surgeon may measure the horizontal palpebral fissure and recommend canthoplasty at the time of blepharoplasty to favor a more almond and less round eye. In some cases, the issue is less about the canthus and more about a heavy upper eyelid. When this is the case, the surgeon will suggest an upper eyelid ptosis repair which may appropriately be combined with a canthoplasty.
- Functional Concerns: If you’re experiencing issues such as drooping eyelids, ectropion, or entropion, canthoplasty may be recommended as a corrective procedure. In such cases, the surgery can improve both the appearance and function of your eyelids, leading to better eye health and comfort.
- Age-Related Changes: Aging often results in the loss of skin elasticity and muscle tone, leading to sagging eyelids. If this is causing you to look older or more tired than you feel, or if it’s affecting your vision, canthoplasty could be a beneficial procedure to consider. However, it is seldom recommended in isolation. It might be offered with lower eyelid blepharoplasty etc, depending on the situation.
- Previous Surgeries: If you’ve had previous eyelid surgeries that resulted in complications like lower eyelid retraction, canthoplasty might be necessary to correct these issues. It is seldom useful in isolation. Generally, it is recommended as a component of other repair work used to restore the appearance and function of a damaged lower eyelid. It’s essential to consult with a skilled and experienced oculoplastic surgeon who can assess your situation and determine the best course of action.
- Personal Comfort and Confidence: Ultimately, the decision to undergo canthoplasty should be based on your personal comfort and confidence. If you feel self-conscious about the appearance of your eyes or if functional issues are affecting your quality of life, discussing canthoplasty with a qualified surgeon can help you explore your options.
Risks and Considerations
Like any surgical procedure, canthoplasty carries certain risks, including infection, scarring, asymmetry, and changes in eyelid function and appearence. It’s crucial to have a thorough consultation with an experienced oculoplastic surgeon who can evaluate your specific needs, discuss the potential risks, and guide you through the decision-making process.
Additionally, consider that the trend for cat-eye or fox-eye looks may evolve, and permanent surgical alterations may not always align with future aesthetic preferences. A good surgeon will help you weigh the long-term implications of the procedure.
Conclusion
Canthoplasty can be a highly effective procedure for those looking to enhance their eye shape or correct functional eyelid issues. Whether you’re motivated by aesthetic desires or the need to address age-related or medical concerns, it’s essential to approach the decision with a clear understanding of the procedure, realistic expectations, and careful consideration of the risks involved.
If you’re considering canthoplasty, consult with a board-certified oculoplastic surgeon who can provide personalized advice based on your unique anatomy and goals. This will ensure that you make an informed decision that aligns with your desired outcome and long-term satisfaction.
Dr. Steinsapir is a world-renowned cosmetic surgeon specializing in eyelid and facial surgery and additionally offers services like cosmetic botulinum toxin and facial fillers. He is a board-certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery. His private practice is based in Beverly Hills and his office includes an accredited surgery center. He specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques. He is sought for his compassion, judgement, and skill in addressing the most challenging issues including the management of prior unsatisfactory filler treatments. Contact us today to schedule your consultation.