Focus on the eyes: The ins and outs of canthopexy and canthoplasty

As the age-old saying goes: "The eyes are the windows to the soul." Often one of the first features noticed by friends, family and strangers alike, the eyes not only help us see the world around us but can also help the world see who we truly are. This also means that our eyes are often the first place we notice change, especially for those who are seeing signs of aging around their eyes.

Two recently popular aesthetic procedures for the eye area are canthopexy and canthoplasty. Both are part of the same family of procedures, and these upper eyelid surgeries offer patients a more rejuvenated, even appearance by altering the supportive structures around the eye. While these procedures may be very similar, the techniques involved and the results achieved can vary greatly between them and they are often suggested for different purposes.

What is a canthopexy procedure and what does it entail? How does it differ from a canthoplasty? How do you determine which procedure is best for you? To answer these questions and gather crucial insight into these types of procedures, we reached out to two ASPS Member Surgeons Kristy Hamilton, MD, FACS, and Ashley Howarth, MD.

An overview of canthopexy and canthoplasty

Generally speaking, both canthopexy and canthoplasty are surgical procedures that involve the eye area. Both are used to create a more youthful and alert appearance by altering the outer corner of the eye, although they typically involve different methods to achieve this result.

"Canthoplasty involves the surgical modification of the outer corner of the eye to correct issues like drooping or sagging of the lower eyelid, providing structural support and improving aesthetics," said Dr. Howarth. "Canthopexy is a less invasive procedure that reinforces the existing canthal structures through techniques such as suture placement or internal fixation, offering subtle enhancement to the shape of the eye."

In addition to differences in techniques for these procedures, the end results can vary between canthoplasty and canthopexy.

"Canthoplasty offers more dramatic and lasting changes but comes with a higher risk profile and longer recovery time compared to the less invasive canthopexy," said Dr. Hamilton.

Canthoplasty is commonly known as "cat eye surgery" because it lengthens the eye opening while lifting the outer corner resulting in a more almond-shaped eye.

Many canthopexy and canthoplasty procedures are combined with other facial aesthetic procedures, such as lower eyelid surgery, to provide the most effective results.

"They can be combined with blepharoplasty surgery, for example," said Dr. Hamilton. "I commonly perform a canthopexy at the time of lower blepharoplasty to help support the lower lid while it is healing."

Determining which procedure is right for you

When deciding which type of procedure is best for the results that you're seeking, it's always important to consult closely with your chosen plastic surgeon.

"Prior to eye surgery, the surgeon will carefully consider the patient's preoperative anatomy and desired postoperative appearance to determine if either of the two procedures is necessary," said Dr. Howarth. 

However, there are some generalities in determining which type of procedure you should pursue.

"Canthopexy is ideal for patients with minor to no lower eyelid sagging, whose outer angle is at or about the desired position, who just need a little extra support," said Dr. Howarth. "Canthoplasty, on the other hand, is for those who need more extensive restructuring to achieve the desired results."

In addition, canthopexy is often chosen over canthoplasty because of its shorter recovery period and lower level of risk.

"Canthopexy is more common given its minimally invasive nature with smaller incisions and favorable safety profile, but the choice ultimately depends on a detailed assessment and the patient's goals," said Dr. Hamilton.

However, this can also be simply due to surgeon preference, as there is not a lot of readily available information on these procedures.

"It is likely attributable to surgeon preference since most patients are not as familiar with these procedures compared to other plastic surgery procedures," said Dr. Hamilton.

What you need to know if you're planning surgery

Whenever you elect to undergo a surgical procedure, there are certain steps that you can take to set yourself up for success. Keep reading to discover what our experts would advise doing to maximize your canthopexy or canthoplasty results.

Find a board-certified plastic surgeon

First and foremost, the most important step in pursuing any plastic surgery procedure is finding a board-certified plastic surgeon who is an ASPS member. The process of certification involves additional layers of expertise and experience, so you can rest assured that you'll be in great hands with any board-certified plastic surgeon.

"Finding a board-certified plastic surgeon experienced in eyelid surgeries who can articulate the differences and recommend the best procedure for your specific needs is crucial," said Dr. Hamilton.

Do your research ahead of time

In addition to finding a board-certified plastic surgeon, it's of the utmost importance to do your research on potential surgeons and what to expect ahead of time.

"Ask to see before and after photos of similar cases and ensure you understand the recovery process and potential risks," said Dr. Hamilton. "Be sure your surgeon is an expert in eyelid surgeries, since these procedures are less common in the plastic surgery portfolio compared to other operations we perform routinely."

Insist on having a full consultation prior to your procedure

When going through the process of choosing a plastic surgeon, it's important to spend the time to have a full consultation with any surgeon that you are considering.

"I can't stress enough the importance of the consultation process when considering these procedures," said Dr. Howarth. "It's crucial to have a thorough discussion with your surgeon to ensure you fully understand what to expect and to establish mutual expectations."

Keep an open line of communication with your surgeon

Throughout the process, make sure that you are clear and communicative with your surgeon during each step. Don't be afraid to approach them with questions, concerns or ideas about what your end result will be.

"Effective communication is key," said Dr. Howarth. "Both you and your surgeon should listen to each other's perspectives and concerns. Building a good rapport and mutual understanding with your surgeon will ultimately guide you towards the procedure that's best suited for your individual needs and goals."

Follow postoperative instructions to the letter

Multiple instructions following a procedure can feel a little tedious or bothersome, it's crucial to follow your surgeon's exact postoperative care instructions in order to achieve your desired results with no complications or setbacks.

"Strictly following those instructions ensures a smooth recovery and minimizes the risk of complications, ultimately leading to the best outcome possible," said Dr. Howarth.

Rejuvenating your look with eyelid surgeries

While our eyes may be one of our favorite features, they are often one of the first places in the face to show signs of aging or imbalance. Through procedures such as canthopexy or canthoplasty, patients can achieve the eye shape and eye rejuvenation of their dreams.

By finding the right board-certified plastic surgeon who is an ASPS member with experience in eye aesthetics, you can set yourself up for amazing youthful, refreshed eyes with either procedure.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.