What Happens During Canthoplasty?

Canthoplasty surgery tightens or reshapes the lateral canthal tendon to lift and support the outer corners of your eyes. Done right, canthoplasty creates a subtle aesthetic lift and structural support. 

In this article, we’ll go over what canthoplasty is, how it works, what it can treat, and how much it costs.

What is Canthoplasty?

Canthoplasty (cat-eye surgery) is reconstructive plastic surgery to create a more elongated, almond-shaped appearance of the eyes. It involves reshaping the outer corner of the eye into an almond or cat’s eye shape. 

Lateral canthoplasty surgery targets the lateral canthus, the outer corner of the eye, where the upper and lower eyelids connect to form a V-shape.

After the canthoplasty surgery, the canthus appears raised, and the eyes become brighter and more expressive. A fellowship-trained, board-certified oculoplastic surgeon must perform canthoplasty surgery.

How Does Canthoplasty Work?

Your eyes rely on the lateral canthal tendon to keep the outer corners firm and slightly elevated. With age, genetics, or previous eyelid surgery, this tendon can loosen, causing drooping or uneven eyes. 

Canthoplasty surgery addresses this by repositioning or tightening the tendon to restore firmness. Surgeons perform different types of canthoplasty, each tailored to specific needs:

• Lateral retinacular suspension. Ideal for moderate laxity without external incisions, often done alongside lower eyelid procedures.
• Tarsal strip canthoplasty. Best for significant tendon laxity or visible droop, effectively tightening and repositioning the canthal corner.
  
• Wedge excision canthoplasty. Suitable for mild to moderate laxity; less common due to potential angle distortion.

How Much Does Canthoplasty Surgery Cost?

The average surgeon’s fee is $3,359 for an upper blepharoplasty and $3,876 for a lower blepharoplasty, according to the latest (2024) statistics from the American Society of Plastic Surgeons (ASPS). 

However, costs range from just over $1,000 to more than $10,000. Various factors will influence how much you pay for canthoplasty surgery. 

These include:

• The location of your plastic surgeon’s office.
• The surgeon’s level of expertise.
• The complexity of your surgery. 
• Whether or not you’re combining it with other procedures, such as canthopexy or blepharoplasty.

What Is Included in the Cost of Canthoplasty Surgery?

During your initial consultation, ask your surgeon for a comprehensive cost estimate. This typically includes:

• The surgeon’s fee
• Facility fees
• Anesthesia
• Cost of presurgical care, such as medications or doctor’s appointments
• Cost of follow-up visits and aftercare

Because canthoplasty is an elective surgery, most insurances won’t cover it unless it’s required to treat a medical problem, such as chronic dry eyes. 

Talk to your doctor and insurance provider about pricing before committing to the surgery. Some doctors offer financing options such as payment plans. 

Who is a Candidate for Canthoplasty Surgery?

Your initial consultation and examination will determine whether this eyelid surgery suits you. The ideal candidate for canthoplasty has:

• Drooping eyelid (loose lower eyelid) due to aging, genetics, or lifestyle
• Good physical health
• No underlying medical conditions that may interfere with recovery
• Enough knowledge of the surgery and typical results
• Realistic expectations
• Is not taking any medications that can cause excessive bleeding

How to Prepare for Canthoplasty?

Before you go through the procedure, your doctor will tell you to do a few things. These include:

• Stop taking blood thinners (ibuprofen, apixaban, edoxaban, Heparin, etc.).
• Eat a light meal the night before surgery.
• Avoid food and liquids at least 6 hours before surgery.
• Take your essential medication(s) as directed by your doctor and surgeon.
• Avoid makeup, as it contains chemical irritants and attracts bacteria.
• Rinse your face with water and soap on the day of surgery.
• Do not apply face lotion or cream.

Because of how the surgery will affect your vision and coordination, you should make arrangements for someone to drive you home after.

What Happens During Canthoplasty?

After administering the local anesthesia, the surgeon will make an incision on the lateral canthal tendon. The surgeon will then detach the tendon and reposition, shorten, or tighten it to achieve the cat-eye shape. 

Once that’s done, they’ll close the incision and dress it to prevent infection. An experienced surgeon can hide the scar by making an incision in the eye’s natural crease.

Cat-eye surgery is an outpatient procedure, meaning you’ll be discharged immediately after surgery. The entire surgical procedure lasts about 2 hours or less. 

Post-Op Recovery Tips

After the procedure, be sure to take time off work and rest your eyes. Clean the wound as directed by your doctor and don’t rub, squeeze, or touch your eyes.

Avoid wearing contacts and makeup for at least two weeks. You should also avoid certain medications, like non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, and anticoagulants, which may increase bleeding.

Be sure to take medications, ointments, or eye drops prescribed by your doctor. Finally, be sure to visit your doctor regularly for monitoring.

How Long Does it Take to Recover From Canthoplasty?

After the procedure, your doctor will prescribe antibiotic eye drops, ointments, or steroid eye drops to relieve pain and discomfort. They may also provide an eyeshield to protect eyes from dust, debris, and potential trauma, especially during sleep.

Here's what your recovery will look like week by week:

• Days 1 to 2. Get some rest and use cold compresses to reduce swelling and discomfort.
• Days 3 to 7. By this time your swelling will peak and gradually subside. You can also expect mild bruising around the area.
• Days 7 to 10. After a week your doctor will start removing your stitches. You can also resume desk work and light physical activity.
• Weeks 2 to 4. Noticeable swelling diminishes, though minor puffiness may remain.
• Months 3 to 6. Full healing.

Following your surgeon’s detailed post-operative instructions closely ensures a smoother recovery and the best possible outcome.

What Are the Risks of Canthoplasty?

Like all surgical procedures, canthoplasty can have risks and side effects. These include:

• Drowsiness, nausea, and vomiting 
• Swelling and bruising
• Blood clots
• Scarring
• Loose stitches
• Excessive tearing
• Dry eyes
• Mild to moderate pain
• Excessive bleeding
• Poor outer canthal alignment
• Conjunctival exposure
• Infections

In most cases, bruising and swelling improve significantly within two to three weeks, though minor puffiness can persist longer. Vision changes are likely in some people, but these symptoms are only temporary and usually resolve quickly.

Seek emergency medical care if you experience severe pain, shortness of breath, chest pains, bleeding, or infection after surgery.