Eye Lift Surgery Overview

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Canthoplasty and canthopexy are cosmetic surgery procedures designed to correct drooping, sagging, and bagginess of the lower eyelids. As people age, their skin becomes significantly less elastic, which contributes to drooping of the lower eyelids and under eye bags. Sagging skin on the lower lid is usually the result of aging and sun exposure, but some people develop bags under their eyes at a relatively young age. The result is an older, tired-looking face. Canthoplasty and canthopexy can remove the under eye bags, refresh, and rejuvenate the face.


Although the term blepharoplasty is often used for all cosmetic surgery for the eyelids, it is sometimes used to refer only to surgery for the upper lids. A blepharoplasty on the lower lids removes fatty tissue and excess skin under the eye, in much the same way the procedure does with the upper eye. The terms canthopexy and canthoplasty apply specifically to surgery on the lower eyelids.

The goal of canthoplasty and canthopexy is to create a younger look to the face and a more attractive appearance. After either procedure, you will look younger.

The Difference Between Canthoplasty and Canthopexy

Although the terms are sometimes used interchangeably, canthoplasty and canthopexy are different surgical procedures. Canthoplasty involves cutting through the orbicularis oculi muscle, detaching the lateral canthal tendon from the bone at the side of the eye socket, and removing a piece of the tendon. The internal structure of the lower lid is then pulled over and attached to the spot on the eye socket where the tendon had been attached. Excess skin may be removed as well. Canthopexy uses sutures to tighten and stabilize the same tendon and muscle without detaching or reconstructing the tendon. The result is the correction of a gaping lower lid that can be combined with removal of excess or sagging skin.

Although canthoplasty and canthopexy can be done strictly for cosmetic reasons—to remove under eye bags and make the eyes and face look younger and more refreshed—either surgery may be required to treat a lower eyelid that is gaping open, a condition called ectropion. Ectropion can cause dryness in the eye and irritation and may lead to eye infections. An ectropion can also be caused by trauma to the eyelid or by surgery to remove skin cancers around the eye.

Canthoplasty is more invasive than canthopexy. Because it shortens the lower lid slightly, if the surgery fails in several years, or if the sagging of the lid progresses, there is not as much tissue in the lower lid that can be pulled up to correct the problem. Some surgeons reserve canthoplasty for people who have functional problems with the eyelid, such as ectropion, and use a canthopexy procedure for cosmetic treatment of the lid.

Health insurance may cover canthoplasty or canthopexy if you have ectropion and a dry eye problem, but will not cover them for purely cosmetic reasons. You will be responsible for the costs of cosmetic eyelid surgery, but financing can be arranged. 

Are You a Candidate for Canthoplasty?

To be a good candidate for any cosmetic plastic surgery, you should be in good overall health, have no pre-existing diseases or medical conditions, and be mentally and emotionally stable. Of course, you must also have loose, sagging, fatty lower eyelids that can benefit from canthoplasty or canthopexy. Most people who decide to have canthoplasty are in their late 30s to mid 40s and older. However, if saggy or fatty lower eyelids exist, this procedure may be beneficial at any age.

You should also have realistic expectations about what lower eyelid surgery can do for you. The surgery can tighten up the lower lid area, remove under-eye bags and help rejuvenate your face. It cannot improve dark circles under the eyes in most people, unless the dark area is related to shadows caused by bulging fat in the lower eyelids. Many dark circles under the eye are pigment problems of the skin, so no amount of tightening would help.

You must also remember that while a procedure performed by a cosmetic surgeon can help improve your appearance, it cannot improve anything else in your life. You may feel better and have increased self-confidence if you look younger, but cosmetic surgery cannot help you if you are depressed or dealing with other mental or emotional problems.

Some people are not good candidates for canthoplasty. Anyone who has swollen or fatty looking eyelids due to an underactive thyroid gland (hyperthyroidism) or myxedema is probably not a good candidate for canthopexy. Canthopexy and canthoplasty are also not effective for reducing edema (swelling from fluid retention) of the eye area.

If you are considering canthopexy surgery, you should familiarize themselves with the risks, complications, and contraindications of the procedure. Also, during your pre-surgical consultation, you should view eyelid surgery before and after photos so that you can have a better understanding of the potential results from surgery. Your surgeon can also discuss with your eye lift surgery recovery time and the cost of eyelid surgery.

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How a Canthoplasty Is Performed

A canthoplasty or canthopexy normally takes 1 to 2 hours to perform. If other procedures are being performed at the same time, surgery will take longer. Cosmetic surgical procedures that can be combined with a canthoplasty include blepharoplasty or a face lift.

Incisions are usually hidden within a crease at the outer corner of the eye so that the scar blends in and is hidden. Most blepharoplasty procedures on the lower lid use an incision on the inside of the lid through the membrane, or the conjunctiva, called a transconjunctival incision. 

Most eyelid surgery can be performed in a surgeon's office, a freestanding surgical clinic, or in a hospital. The surgery is usually done under local anesthesia, with the eye area numbed. You will be given a sedative to keep you calm and relaxed. You can go home after your surgery, but will need someone to drive you.

There are several phases involved in the surgery for the lower eyelid:

Preparation: During this stage, the surgeon uses a marker on your eyelid to indicate where incisions will be made. In most cases, you will be hooked up to an intravenous (IV) line for the administration of medications. You may also be attached to monitors that will keep track of your vital signs.

Anesthesia: You should discuss the choice of anesthesia with your surgeon before the day of your surgery. Generally, local anesthesia and sedation are used for canthopexy and canthoplasty. You are awake, but very drowsy and you do not feel anything.

Surgical Procedure: The surgical procedure on the eyelids begins after the anesthesia is administered. During the surgery, a clear plastic shield will protect your eyeball. When the surgery is complete, the shield is removed and the incisions are closed. A dressing is then applied to protect the wounds, keep the tissue securely in place, and reduce swelling.

Recovery:i have a meeting at During the recovery phase, you wake up and are moved to a recovery room where you will be monitored for an hour or so. You may feel some discomfort, nausea, or cold as you recover from the anesthesia. You can ask for pain relievers, anti-nausea medications, blankets, or other assistance.

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