Restore your youthful, energetic eyes with this minimally invasive cosmetic procedure


Patients who are experiencing drooping, sagging or bagginess of the lower eyelids may be candidates for a canthoplasty. These problems may appear for a variety of reasons, including unsatisfactory result from previous surgery, age, hormonal conditions, hereditary factors, trauma, or paralysis. All canthal procedures have a common goal of supporting or tightening the lower lid at the canthus (outer corner of the eyes). These procedures include both a canthoplasty and canthopexy, and Dr. Guy Massry more generally refers to this group of surgeries as “canthal suspension” procedures as this is their general purpose, and the name includes all variations on surgical techniques. 

Irrespective of the primary cause, canthal suspension, as a means of addressing preexistent lower eyelid laxity, has become an integral part of lower blepharoplasty and reduces the incidence of post-operative eyelid malposition and unsatisfactory results. In addition to maintaining aesthetics, when canthal suspension is added to surgery, eyelid function is preserved. Unaddressed eyelid laxity can lead to weaken eyelid mechanics, causing problems such as inadequate blinking and ocular surface exposure.

Dr. Massry performs a very careful analysis of lower lid function, position, tone, laxity and midface configuration (extremely important that this is done prior to surgery) in consultations with patients who wish to undergo blepharoplasty to determine if there is a need for canthal suspension. Additionally, a thorough understanding of the patient’s canthal and lower eyelid anatomy is critical to attaining the best possible outcomes and avoiding surgical complications.

Canthoplasty With Horizontal Eyelid Lengthening


The goal of a canthoplasty is to improve one’s appearance in a natural way – NOT to change one’s look. This procedure may be a necessary step in lower lid blepharoplasty to prevent altering the shape of the eye.

Canthal Suspension Surgery

The goal of any cosmetic blepharoplasty should be to improve one’s appearance in a natural way – NOT to change one’s look. Unfortunately, one of the major complications of lower eyelid blepharoplasty, when performed by a surgeon with little experience in eyelid surgery, is a retracted (pulled down) lower eyelid. This leads to a change in the shape of the eye, a rounded outer corner of the eye, and sometimes a “starry or wide-eyed appearance.”

So, how can complications from lower eyelid blepharoplasty be avoided? First, a preoperative assessment of eyelid laxity (looseness), and excess skin must be made to determine what surgical intervention is necessary. Next, the surgery should be performed from the inside of the lid, a transconjunctival blepharoplasty, as it reduces the chance of altering the shape of the eye. Again, this is why it is so important to find a surgeon who specializes in eyelid surgery. This type of surgery is difficult to do and the surgeon must be well versed in this procedure to perform it correctly.

If the lid is loose, or if there is skin to be excised, the lid may need to be tightened for support. The lid tightening procedure, as stated, is called a canthoplasty. This procedure may be a necessary step in lower lid blepharoplasty to prevent altering the shape of the eye. If the lid requires less support, then the canthopexy method can be utilized, as it is a less aggressive approach.

What is the Difference Between Canthoplasty vs Canthopexy?

A canthoplasty is a procedure in which the lateral canthus (area where upper and lower lids meet laterally) or temporal lower lid is incised, plus/minus shortened, and secured to the lateral orbital rim. Conversely, a canthopexy is a procedure in which the lower eyelid is suspended to the lateral orbital rim (bone of lateral orbit) with a plication suture without modification of the lateral canthus or terminal tarsus. Essentially, a canthoplasty is a more powerful, yet complex and involved procedure than canthopexy. Upon examining the patient, Dr. Massry will determine which procedure will provide the best results for the individual’s needs.

Canthal suspension procedures may be performed in conjunction with a primary blepharoplasty or as a revision procedure to correct lower lid complications from a prior surgery.

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