Last updated date: 09-Mar-2024

Medically Reviewed By

Written by

Dr. Anas Walid Shehada

Originally Written in English



    Natural aging, environmental factors (such as unprotected sun exposure), and lifestyle choices (such as smoking) all contribute to unattractive sagging/drooping of the lower eyelids and the formation of visible under eye bags. These unwanted aesthetic alterations can substantially age one's face look and give the impression that one is always weary or dissatisfied.


    Lower Eyelid Surgery

    Lower eyelids may lose skin/muscle tone and fat buildup with time, resulting in bulging behind the eyes and the creation of eye bags. Lower blepharoplasty surgery helps rejuvenate lower eyelids by repositioning or eliminating excess fat and, where necessary, tightening and reinforcing loose or sagging tissue. The end effect is smoother skin, softer wrinkles, and better eyelid function.

    There are several operations that may be performed under local anaesthetic, sedation, or general anesthesia. Incisions are made either under the lash line, where they fade fast, or inside the lid (transconjunctival surgery), where they are completely invisible. The lower eyelid, with its related canthal ligaments and cartilage (tarsal plate), is one of the most beautiful and complicated face features. It shields the eye and keeps the eyeball wet and healthy.


    Muscle-conserving Lower eyelid surgery

    Though there are numerous techniques to treating the lower eyelid, the best strategy is to spare or redistribute tissue rather than remove it, and to keep the lid and periorbital region full.

    The transconjunctival approach, which includes cutting along the inside surface of the eyelid rather than through the outer skin, is employed for the majority of cosmetic lower eyelid surgery. Fat is then carefully removed or redistributed to restore fullness to the eyelids. This type of access protects the structural integrity of the eye muscle and nerves while preserving motor function. Furthermore, the healing process is accelerated, resulting in no apparent skin scarring. 

    Along with transconjunctival eyelid surgery, there are other alternatives for addressing loose skin. Microsurgical skin trimming, skin peeling, and laser skin resurfacing are examples.


    What is Canthopexy?

    Canthopexy can correct drooping or sagging eyelids caused by UV damage, previous eyelid surgery, aging, or paralysis. This operation commonly tightens and moderately elevates the lower eyelid to alleviate symptoms associated with excessive conjunctival and corneal exposure (such as weeping, inflammation, irritation, redness, and blurring of vision) and to enhance the look of the lower eyelids and eyes.


    Who is in need of Canthopexy?


    Sagging of the eyelids can be caused by a reduction in muscle tone or skin tone due to aging, trauma, or other circumstances. You will benefit from a canthopexy if you have lower eyelid bags and are constantly hiding them with make-up. A canthopexy operation tightens and strengthens the lower eyelids while reducing wrinkles and increasing eyelid function. To enhance your outcomes, a fractionated CO2 laser and periorbital Dysport can be added.

    Beyond cosmetic enhancement, this procedure can address:

    • Eyelid retraction
    • Eyelid margin eversion
    • Paralytic lagophthalmos, or partial closure of eyelids
    • Ectropion, or droopy eyelids
    • Entropion, or inward turning of the eyelid


    Canthopexy Pre-operative Considerations

    Canthopexy Pre-operative Considerations

    Lower eyelid sagging causes real symptoms, so insurance coverage is frequently available. Following your consultation, the office staff will assist you in contacting your insurance company to inquire about possible pre-authorization.


    What does Canthopexy involve?

    Canthopexy involve

    Canthopexy is the procedure of strengthening the drooping outer corner of the eye. This method can improve the tightness of the lower eyelid as well as correct the contour of the eye. This tissue-saving treatment involves strengthening the existing tendon with stitches rather than cutting or removing it.

    Canthopexy can be performed alone, although patients frequently combine it with the excision of extra skin in the lower lid (pinch surgery) and tightening of the Orbicularis Oculi muscle. This surgical method enhances eye muscle tone and aids in the raising of the tissues of the depressed lower eyelids. The process also softens the abrupt drop between the eyelid and the cheek, transforming it into a more gentle and youthful slope.

    Canthopexy is frequently used in conjunction with lower or upper eyelid surgery to tighten the levator muscle and lift the eyelid. Some people choose for this procedure in combination with a facelift.

    Canthopexy is a quick procedure that may frequently be completed in less than 30 minutes. The procedure is carried out under local anaesthetic. The patient does not require hospitalization and can return home the same day. This eyelid-tightening procedure is typically performed with sutures that are strategically anchored to hold the eyelid in place. These sutures are completely safe and result in tighter, younger-looking eyelids.


    Canthopexy Post-operative Recovery

    Canthopexy Post-operative Recovery

    This technique only covers a tiny region and typically results in little discomfort or other side effects. Local swelling and bruises often last one to two weeks. The white part of the eye (sclera) and the clear membrane that covers it (conjunctiva) may turn red for a short period of time. Most patients require only one to two days out from work to recuperate.


    What are the limitations of Canthopexy?

    limitations of Canthopexy

    One of the most challenging challenges your Oculoplastic surgeon will face is determining the proper tightness. There may be residual laxity of the lower eyelid if the surgeon does not tighten the eyelid adequately. Entropion can occur when the eyelid is squeezed excessively tightly, causing the eyelid to draw inward. The success of the surgery is dependent on getting the tightness just right, not too tight or too loose. 

    When there is any flexibility in the lower lid, it can be severely tightened. The amount of tightening necessary is determined by how loose the eyelid is to begin with, as well as ensuring that the tension is correct at the conclusion of the procedure. During the procedure, the amount of tension may be modified to ensure that it is just correct. If it seems overly tight, the tension can be loosened on the operating table to give it a more natural appearance. ​


    Are the there any Risks and Complications?

    Risk of canthopexy

    There is a little danger to the globe with any eyelid surgery. Canthopexy's particular hazards include a tiny scar if a lateral strip is done, which normally heals nicely. Webbing at the outer corner of the eyelid can occur in a small number of patients, but it is uncommon. There is also a chance that the eyelid will be too tight or too loose after the procedure, as well as a small chance that one eye will appear slightly different from the other.

    Canthopexy vs. Canthoplasty

    Canthopexy vs. Canthoplasty

    Both Canthoplasty and Canthopexy:

    • When the corner of the eyelid has to be stabilized and fortified, these surgical treatments can be performed in conjunction with aesthetic eyelid surgery or as part of a reconstructive operation (for example when pre-operative assessment demonstrates lower eyelid sagging, drooping, and under eye bags).
    • These are not the principal cosmetic operations. Canthal surgery, for example, is unlikely to create enough of a cosmetic impact to be useful on its own, unlike upper or lower eyelid surgery.
    • When performed appropriately by a competent oculofacial surgeon, can successfully contribute to a revitalized and rejuvenated appearance.
    • Can be used to treat eyelid malposition (i.e. ectropion and entropion), which occurs when the lower eyelid is turned out or in, respectively, leaving the eye exposed, dry, and vulnerable to corneal abrasions, infections, or scleral show.
    • Is nearly usually required as part of lower eyelid repair following unsuccessful lower eyelid or midface surgery.



    Canthoplasty differences

    While these terms are sometimes used interchangeably, the techniques involved in canthopexy and canthoplasty surgery are vastly different:



    • Canthoplasty surgery focuses on the outer corner of the eye, where the upper and lower eyelids meet. To achieve a positive canthal tilt, an almond-shaped eye, and a firm, smooth lower eyelid, this junction should be slightly above the medial canthus (where the upper and lower eyelids meet near the nose).
    • Canthopexy is a less invasive technique than canthoplasty. It entails severing the orbicularis oculi muscle, separating the lateral canthal tendon from the bone on the side of the eye socket, and shortening the lateral canthal tendon. The lower lid's internal structure (tarsus) is then pushed over and reattached to the lateral orbital rim at the proper height (often a small amount of skin is also trimmed at the time of surgery).



    • The lateral canthal tendon and orbicularis oculi muscle are tightened and stabilized without removing or repairing the tendon in this less invasive eyelid surgery. This procedure supports the exterior corners of the eyes and reduces the possibility of eyelid malposition following lower eyelid surgery.
    • Canthopexy is generally typically performed as an auxiliary method in combination with other eyelid operations under local anesthetic or IV sedation in an outpatient clinic.
    • Canthopexy is frequently done in combination with lower blepharoplasty (lower eyelid lift) to provide support. Almost all other cases necessitate a more invasive lateral canthoplasty to correct changes in the lateral canthal angle that blunt the angle or make it appear more round and less almond shaped.


    Dynamic Canthopexy

    Dynamic Canthopexy

    Dynamic canthopexy is a flexible operation that can be used on patients who have the lateral canthus lower than the medial canthus (eg, the downslanting palpebral fissure) and who want a more oblique eye look. Before doing drill-hole canthopexy, the surgeon must have a thorough understanding of ocular anatomy. The practitioner must also inform patients that this procedure results in a significant change in the shape of the eyes and can have significant aesthetic and psychological consequences.

    Unless the patient is extensively screened and found mentally fit to undergo this treatment, the surgeon should avoid fulfilling demands for excessive upslanting palpebral fissures. We underline the significance of many detailed preoperative conversations and intensive postoperative monitoring in patients undergoing dynamic canthopexy.

    This sort of surgery is associated with body dysmorphic disorder. In our clinical practice, potential patients are given postoperative images of other patients (at 4 days, 20 days, 3 months, and 1 year) to help them visualize the consequences of dynamic canthopexy—particularly the early postoperative overcorrection.

    If the canthus is only slightly lifted, the surgeon should advise patients that they can expect to resume normal social activities approximately 2 weeks after surgery. However, after a 3 to 4 mm canthal repositioning, the patient may be uncomfortable in social circumstances for 20 to 30 days. Along with overcorrection, the patient is likely to experience edema, chemosis, and epiphora during this time. 


    Canthopexy cost

    The cost of canthopexy surgery is determined by factors such as the total time required to complete the procedure, the techniques used, and anesthesia fees.



    Canthopexy is intended to improve the form of the eyelids, making them seem more young and renewed.