Canthopexy: Pros and Cons

While face lift used to be an operation to remove lots of sagging skin, it has gradually evolved into an operation to reinforce facial muscles and fascial planes, lift up on the major fat pockets, and take off just a little skin.

Blepharoplasty used to be an operation to remove lots of sagging skin and bulging fat. Today, it has become clear that that sort of thinking was both too much and yet not enough at the same time.

Canthopexy is a modification that allows for the stabilization of the lower eyelid's main support tendon and the reinforcement of its closing muscle, thus reducing the amount of both skin and fat removal. If you can't remember much about the operation's specifics, you might want to review them now by clicking on the link below. Otherwise, what follows may not make a lot of sense.

Of course, time marches on. Just as facial surgeons have begun to appreciate the superiority of volume restoration and preservation over reinforcement techniques, newer eyelid tissue-sparing procedures have diminished canthopexy's necessity. At present, however, it remains a mainstay in oculoplastic surgery.

Pros

• Stabilization of the Lateral Canthal Tendon

The lateral canthal tendon with its attached retinaculum is a major support element of the lower eyelid. With age, it weakens. The lid then undergoes a subtle realignment and slackening. Canthopexy strengthens and stabilizes the canthal tendon.

• Reinforcement of the Orbicularis Muscle

Another important support element for the lower eyelid is the orbicularis muscle (the eye's main closing muscle). The muscle's tone helps push the eyelid into its normal position of contact with the eye. With aging, the muscle can thin and stretch and sag.

While several operations have been designed to cut out sections of stretched muscle with the goal of strengthening, any procedure that cuts through muscle will not only turn it into scar but may also end up doing exactly the opposite of what was intended. We try to avoid such procedures that can produce negative consequences as time passes and the lid ages.

So, canthopexy allows for some reinforcement of the muscle but in a more non-destructive manner.

• Slight Restoration of Uplift at the Outer Corner

As the lower eyelid ages, it is not unusual for the outer angle to drift slightly downward, a change that can detract from the overall brightness of the eye's appearance. Canthopexy can lift the angle back to its previous position.

• Reduction in Amount of Skin Removed

Following canthopexy, the amount of skin that requires removal during lower blepharoplasty can be reduced by as much as one-third. Instead of trying to pull the lid back into shape by yanking on just its outer layer (much like the old-time face lift), the lid is rejuvenated in a more comprehensive manner.

• Reduction in Amount of Fat Removed

Once the orbicularis muscle is reinforced and slightly tighter, it seems to do a better job at holding back the orbital fat. Bulging is thus helped without as much fat removal.

Cons

• When Performed Aggressively, An Exotic Appearance

When performed aggressively and routinely combined with orbicularis muscle suspension, the result may look exotic if not unnatural. Too tight, the lower lids can appear windswept against the curve of the eyeball, as if frozen into a state of contraction like a perpetual but odd smile.

• When Performed Aggressively, A Hollowed Appearance

When performed aggressively with orbicularis muscle suspension procedures, the lower lid may appear hollowed, even if it really isn't.

• An Over-Recommended Procedure

Some surgeons recommend canthopexy to nearly every patient undergoing lower eyelid blepharoplasty. "Blanket" policies are never good policy with any surgical procedure. Especially when performed in patients younger than age 40, the incidence of negative consequences as noted immediately above is not small.

• Prolonged Healing

Canthopexy does not always heal as rapidly as most other components of lower blepharoplasty. In about one-third of patients, the white of the eyeball can remain "blistery" and red for several weeks or more. Tenderness and swelling at the site where the sutures pass through the lining of the bone is common and can last several months.

• Less Commonly Needed With Tissue-Sparing Procedures

Newer procedures (tissue-sparing lower blepharoplasty) allow bulging fat to be repositioned back into the orbit rather and not removed. Since this maneuver enhances lower eyelid support much more naturally, the benefits from and need for canthopexy have diminished.

Best Places to Learn More

Canthopexy: Because a Lid is More Than Skin and Fat (video)

Lateral Canthopexy Photographed Step-By-Step