Canthoplasty: Treatment, Effect & Risks

People who are dissatisfied with their external appearance often seek the practice of a plastic and aesthetic surgeon. Cosmetic surgery is intended to help them increase their attractiveness to other people, especially the opposite sex. Canthoplasties are most often performed in conjunction with eyelid lifts. The patients are women who want to give their eyes a mysterious look. However, there are also cases where there is a medical indication.

What is canthoplasty?

A canthoplasty is a surgical procedure performed on an outpatient basis that is desired primarily for cosmetic reasons. A canthoplasty is a surgical procedure performed on an outpatient basis that is desired primarily for cosmetic reasons. If there is a medical indication, it involves malformations such as narrowing of the eyelid fissure, diseases of the eyelid, injuries to the eye, tumors on the edge of the eyelid and in its immediate vicinity, and age-related unsightly downward distortion of the eyelid axis associated with a weakened lower eyelid. In patients with facial paralysis, it corrects the resulting eyelid angle asymmetry. Glaucoma eyes, which occur as a result of Graves’ disease or myopia (nearsightedness), are made narrower. In canthoplasty, the outer corner of the eye is pulled up a few degrees and fixed in this position. Patients who want this procedure have drooping outer corners of the eyes that give their face an exhausted and sad expression. Lateral eyelid plasty is always performed on both eyes for symmetry. Canthoplasty involves canthopexy, a tightening and fixation of the edge of the eyelid. The surgical procedure is mainly performed as part of a lower eyelid lift. Very sagging lower eyelid skin is corrected by the surgeon by removing skin, muscle and often fatty tissue from under the edge of the eyelid. This usually leads to the appearance of ectropion (postoperative drooping of the lower eyelid, associated with increased lacrimation and conjunctivitis). To prevent this from happening, the surgeon always performs a canthopexy after the lower eyelid lift. He can use the incision already made for the lower eyelid lift. The Pinel test (measuring the tension of the eyelid frenulum) before the operation shows whether the patient still needs a canthopexy during the lower eyelid lift.

Function, effect and goals

Canthoplasties give female patients a particularly expressive look (“cat eyes”). The slightly almond-shaped eyes make them more feminine and exotic. From a medical point of view, canthoplasties are used to correct an already existing or possibly occurring ectropion. During surgery, the lower edge of the eyelid is incised in the outer corner of the eye to gain access to the tendon. The incision is made in the natural curvature of the eyelid so that the scar is later invisible. Then the edge of the eyelid is pulled up slightly. The orbicularis oculi muscle is sutured to the periosteum of the temporal bone. If the canthoplasty is performed as part of a lower eyelid lift, the surgeon uses the 1 cm incision already made for it in the place where there are already natural horizontal folds. If the lower eyelid has too much excess skin, he removes a small piece of skin near the corner of the eye and brings the edges together, resulting in even greater tissue tightening. Surgeons use different procedures when performing canthoplasty. Which one is used later depends on the surgeon’s preferences and the patient’s anatomy. Before surgery, the patient receives intravenous sedation. The surgical area is locally anesthetized. Depending on the complexity of the case, the entire medical procedure takes 1 to 2 hours. The wound is covered sterilely with a small gauze bandage. A few days later, the patient has a feeling of tension in the area of the eyelids. Mild skin irritation may also occur. To relieve the pain, he is given an analgesic to take every 6 to 8 hours. If the patient’s wound heals normally, he will have his stitches removed about 8 days later. If the swelling has not decreased significantly by this time, the stitches may be removed later. The bruises that are often visible after the procedure are not a cause for concern. They disappear after 4 weeks at the latest.Ice packs help the postoperative swelling to subside even faster. The patient can see a first change in his facial expression after 2 to 6 weeks. However, he or she can only assess the final surgical result after a year, when the wound healing process is complete.

Risks, side effects and dangers

Postoperative consequences of canthoplasty may include: dry, itchy or burning eyes, decreased vision (double vision, blurred vision), increased lacrimation and increased sensitivity of the eyes to light. The heavy tearing of the eyes usually disappears after a few weeks. The insertion of contact lenses at the earliest two weeks after the procedure may cause an uncomfortable feeling in the first period. There are risks for the patient only if the surgery is performed by a doctor who is not specialized in canthoplasty and eyelid correction or who does not have many years of experience in this medical field (operations on the lower eyelid are generally more difficult than operations on the upper eyelid!). Otherwise, of course, there may be the usual consequences that surgical procedures can bring: unexpected negative reaction to the anesthetic, unexpected asymmetries, post-operative bleeding, infections, too slow wound healing, etc. In rare cases, canthoplasty causes the corrected corners of the eye to return to their original alignment.