Canthoplasty

What is Canthoplasty surgery?

The appearance of our eyes says a lot about us. We are naturally wired to make judgments about each other based just on the size and shape of our eyes. Many ladies desire bigger and brighter eyes that will make a good impression. Double eyelidplasty, epicanthoplasty, and lateral canthoplasty are surgical procedures that make the eye bigger and brighter.

Double eyelidplasty affects the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty affect the horizontal dimension. Epicanthoplasty is a surgical treatment that enlarges the eye horizontally at the inner corner, whereas lateral canthoplasty enlarges the eye at the outside border.

Adjusting the slant of the palpebral fissure by lateral canthoplasty can accomplish an enlargement of eye width and smoother features, especially if the slant of the palpebral fissure is elevated and the horizontal dimension of the palpebral fissure is short.

Canthoplasty is a surgical treatment used to repair or remodel the lateral canthus (outer corner of the eye). A canthoplasty is a cosmetic surgery that reshapes the corner of the eye. The phrase is derived from the Greek words "kanthos," which means "corner of the eye," and "plasty," which means "to shape". A canthoplasty is a reconstructive surgical treatment used to repair drooping or sagging of the eye's outer corner by raising the canthal angle to produce a larger and brighter appearing eye.

Canthoplasty is performed at the eye's outer corner (the canthus), in the area where the lower and upper eyelids meet, known medically as the lateral canthus. This meeting point should be located near our noses, right above the medial canthus, which is the intersection of the lower and upper eyelids. This usually leads in a "positive" canthal tilt or upward slope, resulting in an almond-shaped eye.

Canthoplasty surgery is performed to repair negative or neutral canthal tilts that cause drooping eyelids, which may cause discomfort to the patient who does not like the appearance of their eyelids. The fundamental underlying biologic principle leading to these eyelid conditions is the loss of lateral canthal support from gravitational or other mechanical factors.

Canthoplasty may be appropriate for someone who has sagging eyelids or whose eyelids seem uneven. This is a highly sophisticated surgery that can only be performed by a highly trained oculoplastic surgeon with extensive expertise in cosmetic eye surgeries.

The goal of canthoplasty is to enhance the form of the eyelids, toning them up and leaving them looking younger and more refreshed. This should be done to enhance our appearance in a natural-looking way, rather than to change our appearance. 

Canthoplasty is not the same as "canthopexy." Canthopexy simply strengthens the canthus without cutting it, therefore it has no effect on the horizontal length of the eyelid or the location of the canthus.

Canthoplasty is a reconstructive surgical technique that tightens the muscles or ligaments that support the outer corners of the eyelids to fix drooping or sagging eyes. Canthoplasty surgery changes the form of the eye. Canthopexy, on the other hand, is a less invasive procedure that, while similar to canthoplasty, does not alter the form of the eye.

Canthoplasty surgery should not be confused with lower lid blepharoplasty, which is another form of eyelid surgery. A blepharoplasty removes extra skin, muscle, and perhaps fat from the lower or upper eyelid to make the eye seem younger, although surgery does not change the shape or size of the eye. In a nutshell, a blepharoplasty removes "baggage").

A canthoplasty, on the other hand, is a cosmetic surgery technique that lifts the eye's outer corner (the lateral canthus), reshapes the eye to a more almond shape, and enlarges the eye-opening. As a result, the eye seems brighter, larger, and more alert. 

Why do people undergo Canthoplasty surgery?

People consider canthoplasties for a variety of reasons, including:

• The skin surrounding our eyes gradually loses elasticity as we age, resulting in unsightly drooping or sagging of the lower eyelids (ectropion) caused by lower lid tendon laxity. This age-related condition is frequently associated with under-eye bags, which can make people appear fatigued or unhappy.
• Eye injury that causes lower eyelid laxity or retraction may need a canthoplasty to repair the misalignment of the outer corner of the eye.
• Other causes that might promote sagging eyelids include prolonged sun exposure without enough skin protection, as well as lifestyle habits such as smoking or excessive alcohol consumption. These issues might also be caused by hereditary diseases, ocular injuries, or paralysis.
• Furthermore, some canthoplasties are performed as revisional surgery because of dissatisfaction with a previous surgical outcome, these revision surgeries aim to repair lower lid issues caused by previous surgery, such as drooping lower lids or eversion abnormalities that reveal too much white of the eye (scleral show)
• Some patients seek canthoplasty surgery to obtain a more almond-shaped eye by elevating a downward slanting eyelid and lengthening the eye's horizontal length.

Who are the best candidates for Canthoplasty surgery?

Drooping of the outer corner of the lower eyelids is expected when the lids loosen with age. However, it can also be caused by skin tightening as a result of inadequate cosmetic surgery, UV damage, and skin cancer surgery. Patients with drooping, sagging, or baggy lower eyelids are often suitable candidates for this sort of surgery, especially if the existing look and shape of the eye make them stressed. When it comes to eyelid surgery, however, there is no one-size-fits-all approach, and what many patients believe they require may not be the sort of surgical treatment that is best for them.

As a result, at a first consultation, the surgeon must thoroughly examine each patient's lower lid function, tone, laxity, and position, as well as their overall face shape. In most cases, the surgeon will do this during consultations with patients who want to have blepharoplasty and may recommend canthal suspension (canthoplasty) at the same time. In some cases, the surgeon may recommend a different type of procedure entirely, which would be more appropriate for addressing the patient's concerns. It is critical that canthoplasty surgery be conducted only by an experienced, highly educated oculoplastic surgeon, as the consequences of improper surgery can be very difficult to repair.

When you are admitted for the operation, the surgeon will generally begin by marking on the eyes with a pen where the incisions will be made after a meticulous evaluation by a specialist where they will examine your eyes' structure and treatment alternatives. Following that, an anesthetic will be provided. This operation is most usually performed under local anesthesia.

How Canthoplasty surgery is performed?

Canthoplasty is a procedure that lifts the muscles in the outside corners of the lower lids, similar to lifting one end of a hammock. Canthoplasty can also be done to alter the contour of the outer corner of the eye if needed. A more complex surgery is often necessary, and a new lower-lid tendon must be fashioned to address the lid laxity.

The concept of tightening the lower eyelid at the lateral canthus (as opposed to shortening the eyelid by mid-lid resection) was first popularized by Bick in 1966. Since then, various methods have been described for the reconstruction of the lateral canthus, with varying success. The evolution of surgical techniques has been driven by unsatisfactory postoperative results.

Canthoplasty is performed at the eye's outer corner (the canthus), in the area where the lower and upper eyelids meet, known medically as the lateral canthus. This meeting point should be located near our noses, right above the medial canthus, which is the intersection of the lower and upper eyelids. This usually leads to a "positive" canthal tilt or upward slope, resulting in an almond-shaped eye.

During your initial visit, your surgeon will thoroughly inspect your eye shape and function and speak with you about your surgical goals. After you and your doctor have decided that a canthoplasty is the best option, your doctor will create the ideal eye shape based on the form, proportion, and symmetry of your eyes.

Canthoplasty is frequently coupled with other face treatments since it concentrates on the lower eyelid. During your consultation, this treatment plan is frequently discussed and developed.

Other eyelid operations, such as blepharoplasty or ptosis surgery, can be coupled with it. You can also combine it with a brow lift or a midface lift. When paired with additional procedures, recovery durations will be longer, but the outcomes will be more remarkable.

Canthoplasty implies performing a canthotomy – cantholysis before resuspending the lower eyelid to the lateral orbital rim periosteum. Your procedure will be done as an outpatient with local anesthetic and, if necessary, IV sedation. The surgery usually takes one to two hours and involves cutting and relocating or tightening the lower canthal tendon. Newer techniques use laser for cutting.

To reduce obvious scarring, an incision is generally placed within the natural crease at the outer corner of the eyelid. The tendon is then stretched to raise the point where the upper and lower eyelids meet, and sutures are used to repair it.

The treatment differs depending on the patient, but the goal is to cut the lower canthal tendon and then relocate or tighten it. An incision in the outer corner of the eye is often performed to reach this tendon. The tendon is pushed into its new place to support the eyelid before being reattached with sutures. A competent eye surgeon will take great care to make the incision within the natural crease of the eyelid, minimizing scarring following surgery.

If a patient just has a little drooping, a less invasive canthopexy treatment can be more appropriate. Both typically take between 1-2 hours, depending on the method employed and whether additional treatments are required. Normally, a shield is used to cover and protect the eyes.

The ultimate outcome of canthoplasty surgery is typically a wide-eyed look with cat-eye eyes (i.e., they slant slightly upwards). This technique is done under local anesthesia or intravenous sedation. 

Lateral tarsal strip (LTS)

The lateral tarsal strip (LTS), popularized in the late 1970s, remains one of the most common canthoplasty procedures performed today. LTS is a powerful technique, very useful in cases of profound eyelid laxity or ectropion in which horizontal eyelid shortening is necessary to achieve adequate eyelid tightening. The degree of tightening can be adjusted for each individual case.

This procedure is particularly effective because of the direct reattachment of the tarsus, the least elastic part of the eyelid, to the lateral orbital rim. Unfortunately, this can also lead to the appearance of shortening of the horizontal palpebral aperture, which is cosmetically undesirable.

Another untoward effect of the tarsal strip procedure is imbrication of the upper and lower eyelids from supra-placement and shortening of the lower eyelid with preservation of the upper eyelid length. A modified LTS procedure that addresses this issue in patients with severe eyelid laxity, as seen in floppy eyelid syndrome, has been described.

What happens after Canthoplasty surgery?

Following the procedure, a temporary protective covering is put over your eyes. If you remove your protective eye shields following your operation, you will discover that your eyesight is clouded. This is due to an antibiotic ointment that is administered to your eyes during surgery to keep them from drying out. To avoid infection, you'll be given this ointment and told to apply it multiple times each day inside your eye and on your incision.

You will be told to bring someone with you to surgery who will drive you home. It is recommended that you have someone stay with you for the first day or two following the surgery since you will be most comfortable with your eyes closed and covered with protective eye shields.

Recovery from a canthoplasty is comparable to that of other eyelid surgeries, it usually takes two to three weeks. Most patients report edema and bruising, which go away within two weeks but may take many more weeks to completely recover. After a few months, the complete results will be seen.

It is very crucial to follow your doctor's post-op recommendations during this period to minimize problems and damage to the sensitive soft tissue surrounding your eyes. In addition to artificial tears, you may be prescribed ointments or eye drops to prevent infection. To treat eye edema, steroid drops may be required.

Initially, recovery may be a little unpleasant. In the case that pain medication is required, your doctor can prescribe it. If you need pain relief, you can take Paracetamol pills. During the first 24 hours after surgery, a tiny quantity of blood ooze is usual.

For 10 days, no bending, lifting large things, or hard workouts. Swelling is normal and can range from moderate to severe. A cold compress should be used often during the first two days. Fill a clean dish with cold water, then soak a clean facecloth in it and squeeze it out. Cover the incision with a facecloth. When the cloth is no longer cool, rinse it in cold water again. A cold compress will help to minimize swelling and pain.

For at least one month following surgery, you should avoid taking showers, splashing your face, and wiping your eyes. Strenuous activity should be avoided for at least two weeks, or until your doctor visits you and confirms it's safe. Makeup is normally allowed after two weeks.

After eye surgery, pain, bruising, and swelling are usual, but they should go away in 7-14 days. Initially, try to keep your head up and obtain as much rest as possible. For 2 weeks, patients should refrain from exercising, scratching their eyes, or wearing make-up.

People may feel a change in their vision in certain circumstances, but this should only be transitory, with normal vision returning without medical intervention. It is suggested that patients avoid putting strain on their eyes following surgery by not looking at their phones, reading, or watching TV. Contact lenses should be avoided for many weeks following surgery.

Following canthoplasty surgery, full recovery usually takes 2-4 weeks, during which time it is critical to follow your surgeon's post-operative instructions and attend any planned follow-up visits. A good surgeon will aim to make the scar less visible and covered by the natural crease of the eye.

To be conducted properly, canthoplasties need a high degree of expertise and experience. Canthoplasty is considered a permanent remedy for eyelid malposition when performed by a highly trained board-certified oculoplastic surgeon, and revision operations are seldom required.

Are there any risks or complications from a Canthoplasty?

Only doctors with extensive competence in oculoplastic surgery should undertake this procedure. When executed poorly, the consequences might be severe.

Every operation has some risks, although major complications from a canthoplasty are relatively uncommon. Swelling and bruising are normal in the first few weeks after surgery, and they usually go away within two to three weeks. During the first several weeks following surgery, you may also have dry eyes, excessive tears, and hazy vision.

Incisions are made on the outer surface of the lower lids for this technique. Complications are possible, although they are uncommon. Infection is always a danger, although it is uncommon following lid surgery. Although hemorrhage can occur and have an impact on vision, it is extremely rare with laser surgery.

A drooping eyelid can be caused by damage to the muscle in the upper or lower lid. Precautions are made to prevent this from happening, but if it does, it is repairable. Damage to a lower lid muscle might cause double vision but it is very rare.

If too much skin is removed from the top eyelid, closing the eye may become difficult. Lower lid surgery causes the lid to sit away from the eye owing to swelling, however, this normally settles soon. A scar may form as the top lid skin is incised. The incision is in the crease of the lid and will diminish with time. However, if one scars severely, it may become more visible and necessitate correction.

Asymmetry of the lid is possible and may necessitate correction. If the laser is directed directly at the eye, it might cause damage. Some surgeons employ specially constructed eye shields to prevent this from happening. Some pain, swelling, and maybe bruising may occur; fluid may gather over the white of the eye and is typically temporary; however, the use of laser reduces this.

During your pre-operative appointment, your surgeon will go through all of the potential risks and problems of your surgical procedure in detail. This information will also be sent to you in writing so that you may evaluate it as part of the consent process.

Is there an alternative to canthoplasty surgery?

Although not exactly an alternative, canthopexy is a less invasive treatment that employs carefully placed sutures to tighten and stabilize the lateral canthal tendon rather than cutting the tendons. As a result, recuperation time is less than with a canthoplasty. However, it is unusual for a canthopexy not to be performed in combination with another type of lower eyelid surgery. 

Conclusion

Canthoplasty is a type of reconstructive plastic surgery used to tighten drooping eyelids and provide a more natural and desirable face look. It is performed by surgeons on the lateral canthus (the inner corner where the lower and upper eyelids meet). Canthoplasty is a reconstructive plastic surgery procedure that tightens sagging eyelids. Oculoplastic surgeons execute the operation, often known as almond eye surgery.

Eyelid surgery allows you to see better and have a more natural (and maybe more appealing) appearance. Most medical insurance policies do not cover the operation since it is deemed cosmetic and elective.

A canthoplasty is a procedure that includes altering the eyelids from the canthus to create the appearance of a brighter-looking eye. Canthopexy, on the other hand, is less intrusive and treats less severe laxity. Sutures are used to reinforce and repair the outer section of the eyelid, finally stabilizing it.

People who have lower eyelid mal-positioning (sagging, drooping or bagginess) are the most likely candidates for canthoplasty. Furthermore, the ideal individuals are emotionally and physically stable, with no pre-existing medical issues. Candidates should also have reasonable surgical expectations.