Canthoplasty

9 sources cited
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What is Canthoplasty?

Canthoplasty (commonly known as cat-eye surgery) is cosmetic eyelid surgery. It involves reshaping the eyelids to assume a cat’s eye shape, which is often considered attractive and youthful. 

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

After canthoplasty, the canthus appears raised, and the eyes become brighter, just like a cat’s eyes.

Sometimes, eye doctors refer to canthoplasty as cat-eye lift surgery. 

Aside from enhancing looks, canthoplasty can also treat ectropion. Ectropion means the lower eyelids are turned outwards. This increases the chances of eye infections and other vision complications, especially due to overexposure to dry air, dust, and environmental debris.1 

Severe ectropion may require canthoplasty to restore the integrity of the eyelids.

Cat-eye surgery must be performed by a highly skilled oculoplastic surgeon.

Who is a Candidate for Canthoplasty?

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
  • Refrained from certain medications that can cause excess bleeding
  • The ability to follow post-op care guidelines

How Much Does Canthoplasty Cost?

Canthoplasty is an elective procedure, so insurance will likely not cover it unless it’s required to treat a medical problem, such as chronic dry eyes

The American Society of Plastic Surgeons (ASPS) estimates the cost of canthoplasty at about $4,120.2 Cost may vary based on your location, available facilities, and the surgeon’s experience.

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

Canthoplasty Procedure: What to Expect

Cat-eye surgery is an outpatient procedure, meaning you’ll be discharged immediately after surgery. It uses local anesthesia and intravenous sedation to ease pain and help you relax throughout the procedure.3

If your doctor needs to do something more invasive, they will use general anesthesia to make you fall asleep.

The entire procedure lasts about 2 hours or less. 

Preparing for the Procedure

Preparation is important before any reconstructive surgery. You will be required to do the following before canthoplasty:

  • Stop taking blood thinners (ibuprofen, apixaban, edoxaban, Heparin, etc.) 
  • Eat light the night before surgery
  • Avoid food at least 6 hours before surgery to prevent or reduce aspiration (common during general anesthesia)
  • Take your essential medication(s), such as hypertensives, if applicable, to avoid surgery complications
  • 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
  • Make transportation arrangements, as your driving ability will be temporarily impaired after surgery
  • You may not be able to perform normal activities such as driving to the store or cooking 

Procedure Steps

After administering the local anesthesia, the surgeon will make an incision on the lateral canthal tendon.4 The lateral canthal tendon attaches the eyelids to eye muscles supporting the structure and function of the eyelid.

The surgeon will then detach the tendon and reposition, shorten, or tighten it to achieve the cat-eye shape. An experienced surgeon can hide the scar by making an incision in the eye’s natural crease. 

If the eyelids are just slightly sagging, a minimally invasive approach known as canthopexy may be the best option. This procedure eliminates tendon detachment.5 Instead, the surgeon will tighten the eyelids using thread-like stitches known as sutures. 

Aftercare & Recovery 

After surgery, the ophthalmologist will close the incision and dress it to prevent infection.

They will prescribe antibiotic eye drops or ointments, steroid eye drops, and/or artificial tears to relieve any pain and discomfort.

They may also provide an eyeshield to protect eyes from dust, debris, and potential trauma, especially during sleep.

Follow these post-op care instructions for successful recovery:

  • Rest your eyes. Take off time from work or other commitments. 
  • Use an ice pack to ease swelling.
  • Maintain good eye hygiene to prevent infection. Clean the wound with 3% hydrogen peroxide and warm water three times a day for effective cleaning.
  • Avoid rubbing, squeezing, or touching your eyes, which may prolong healing or cause other complications.
  • Don’t wear contact lenses for about 2 weeks to avoid straining the healing tendons. 
  • Avoid medications such as non-steroidal anti-inflammatory drugs (NSAIDs), platelet inhibitors, and anticoagulants that may increase bleeding.6
  • Wear protective eye shields while outdoors or sleeping to avoid accidental injury or exposure to dust, pollen, and other irritants.
  • Attend follow-up visits with your surgeon for close monitoring of the healing wound.
  • Wear sunscreen. Direct sunlight can slow the healing process and cause scar enlargement or skin discoloration. Using sunscreen while recovering will help prevent scar complications.
  • Take your medications. Your surgeon will prescribe pain medication, ointments, and/or eye drops. Take them as prescribed. 

For most people, recovery takes 2 to 3 weeks. Full recovery may take several more weeks.

The recovery process happens in three stages: bruising, swelling, and scar formation. The scars will disappear with time.

The full effects of the surgery (cat-eye-shaped eyes) will become apparent after a few months.

What are the Side Effects & Risks of Canthoplasty? 

Side effects of canthoplasty include:

  • Drowsiness, nausea, and vomiting due to anesthetics and sedatives used during surgery
  • Swelling and bruising
  • Bleeding
  • Blood clots
  • Scarring
  • Loose stitches
  • Excessive tearing
  • Dry eyes
  • Mild to moderate pain
  • Swelling

In most cases, bruising and swelling will disappear within a week. Vision changes are likely in some people. These symptoms are only temporary.

Potential risks of cat-eye surgery include:

  • Excessive bleeding
  • Poor outer canthal alignment
  • Conjunctival exposure
  • Infections

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

Outlook & Success Rates

According to studies, the average success rate of canthoplasty is over 90%.9

Canthoplasty can be safe, reliable, and successful if done correctly. Trained and knowledgeable ophthalmologists should perform the surgery and only on suitable candidates. 

Depending on the person’s condition, other surgeries, such as double eyelidplasty or epicanthoplasty may be necessary to provide the best results.8

Summary

Canthoplasty is an inpatient surgical procedure that improves the eye’s appearance. It involves cutting, repositioning, shortening, or removing excess skin from the outer part of the eyelids. 

Once done, the eyes assume a cat’s eye shape, which is a commonly desired cosmetic feature.

Canthoplasty also corrects drooping eyelids and ectropion, a condition characterized by outwardly turned lower eyelids. 

For best results, only an experienced eye surgeon should perform this procedure.

9 Cited Research Articles
  1. Ectropion,” Mayo Foundation for Medical Education and Research (MFMER), 05 Jan. 2021
  2. Eyelid Surgery,” American Society of Plastic Surgeons
  3.  Trapasso M. “Local Anesthesia for Surgical Procedures of the Upper Eyelid Using Filling Cannula: Our Technique,”  06 Jun. 2014
  4. Parent A. et al.,“Significance of the lateral canthal tendon in craniofacial surgery,” National Center for Biotechnology Information (NCBI), Apr. 1993
  5. Moe K. & Linder T. “The lateral transorbital canthopexy for correction and prevention of ectropion: report of a procedure, grading system, and outcome study,” Mar. 2000
  6. Medications to Avoid Before and After Surgery,”  Washington University Orthopedics
  7. Effects of Anesthesia,” American Society of Anesthesiologists
  8. Chae S. and Yun B.,“Cosmetic Lateral Canthoplasty: Lateral Canthoplasty to Lengthen the Lateral Canthal Angle and Correct the Outer Tail of the Eye,” National Center for Biotechnology Information (NCBI), 20 Jul. 2016
  9. Maamari R. et al.,“Medial canthoplasty for the management of exposure keratopathy,” Journal of Ophthalmic Inflammation and Infection, 01 Feb 2019.
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