Canthopexy

Canthopexy is the name of an eyelid surgery used to strengthen the lateral canthal tendon and surrounding supporting structure known as the lateral retinaculum. The orbicularis muscle is also reinforced in the process.

The goal is to strengthen the tissues of the canthus to help maintain the normal position and relationship between the eyelid and eyeball. Canthopexy is typically used as part of lower eyelid blepharoplasty, especially when done from a transcutaneous approach.

Canthopexy is non-destructive in that the canthal tendon is not disinserted as is done with canthoplasty. It is thus a relatively weak but also safer and less complex procedure.

Primary goal: The main goal of canthopexy is to strenthen support of the lateral canthal tendon at the outer corner of the eyelids.

Secondary goals: While canthopexy is sometimes said to less the chance of eyelid malposition after blepharoplasty undertaken from the skin surface of the lower lid, any protective effect is temporary and usually insufficient in more than very conservative cases.

Operation: Canthopexy is seldom undertaken as a stand-alone procedure but is rather an added component of full lower blepharoplasty. It should not be confused with canthoplasty.

A skin incision exposes the orbicularis muscle in the lower eyelid. At the outer corner, two stitches are introduced into the muscle and then angled upward to engage the lateral canthal tendon and its surrounding retinaculum. The suture then passes upward towards the bony rim, where the needles are passed through the periosteum lining the bone. Tied to one another, the sutures provide added support to both canthal tendon and retinaculum.

Variations: Techniques may vary surgeon to surgeon, some of whom describe the procedure as a “simple stitch” in the corner. Unfortunately, such slap-dash procedures do not often identify the proper anatomy or achieve the added support. Even well-performed, the procedure does not produce cut edges that promote a more permanent effect but only a temporary cinching up of tissue. Consequently, much of the effect is fleeting.

Advantages: If skin removal is needed but eyelid support at the outer corner is weak, the added tension may overpower a weak canthal system. Canthopexy can allow for temporary stronger fixation during healing. Canthopexy will not, however, prevent lower eyelid retraction when employed during the older method of transcutaneous approach to the orbital fat.

Risks and complications: Swelling on the both the eyelids and eyeball can be increased after canthopexy due to interference with the lymphatic drainage (chemosis). While this is temporary, it may persist for several weeks and rarely several months. While some surgeons routinely empoy canthopexy in all low lid blepharoplasty, a better approach seems to be emply safer procedures that do not stress the eyelid’s normal support system.

What results should I expect from a cantophexy?

  • It gives the eyes an almond shape.
  • It lifts the external corners of the eyes when they are sagging, eliminating the tired and sad appearance of the eyes.
  • It tightens lax (hypotonic) lower eyelids and corrects ectropion (inversion of the eyelid).
  • It shapes the eyes when they are too rounded, like those of patients that suffer from hyperthyroidism or due to other factors.
  • In patients that suffer from myopia, it prevents the “bulging eye” effect that may develop after a blepharoplasty of the lower eyelids.
  • It partially corrects asymmetries after a facial paralysis.
  • It is an ideal complement for blepharoplasty.

What results should I NOT expect from a cantophexy?

  • It doesn’t remove crow’s feet.
  • It is not recommendable to combine Canthopexy with Facial Feminization Surgery when a forehead contouring is involved, since reshaping the orbital rims produces too much swelling on the area.
  • Is not a facial feminization surgery

After the surgery

How long will I have to stay hospitalized for canthopexy?

Canthopexy is done on an outpatient basis.

What kind of bandages will I need, when will they be removed?

You will not need any bandages, only some little pieces of gauze and tape.

Will I feel a lot of pain from canthopexy?

The pain after canthopexy is moderate. Your eyelids will be tense and irritated for some days. Your facial surgeon will indicate you to take analgesics every 6 or 8 hours; this will make you feel quite relieved. Eye drops will also be helpful.

When will the stitches from canthopexy be removed?

Between 4 and 7 days after the surgery.

What about swelling and bruises after canthopexy?

They are mild and usually take between two weeks and a month to disappear. They will be at their worst during the first week but, at time goes by, they will slowly disappear or migrate to lower facial areas. Cold compresses will help reduce the bruises and swelling. You will have to sleep with your head elevated for a few days.

What will the scars look like after canthopexy?

Since the facial surgeon makes the incisions along the natural folds of the eyelids, the resulting scars will be disguised.

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