Lateral Canthopexy and the Youthful Eye

Dr. Michael Yaremchuk, September 16, 2014

The shape of the eye is determined by the relation of the upper and lower eyelids (or palpelbrae). The space between the upper and lower lids that frames the eye itself is called the palpebral fissure. In young adults with normal facial skeletons, this opening is long and narrow.

Heredity, aging, paralysis, trauma and previous surgery can all impact this youthful shape. Aging eyes have a rounder shape, due to the gravitational descent, or droop, of the lower lid, and the medial migration of the lateral canthus (when the outer corner of the eye, where the eyelids meet, moves inward).

Standard blepharoplasty (eyelid surgery) techniques, which remove lower eyelid skin, and often muscle, tend to drop the lower lid margin, further rounding the palpebral fissure. Newer blepharoplasty techniques, including arcus marginalis release with fat transposition, have been designed to avoid this rounding effect.

Two related procedures, canthopexy and canthoplasty, are used to elevate the lower lid when it has already fallen or to prevent it from falling during a lower eyelid procedure. They work in different ways, and I only recommend one of them for my patients.

In my opinion, canthoplasty should be avoided in cosmetic eyelid procedures because it produces a rounder eye shape. By design, canthoplasty procedures make the lower lid frame the eye more roundly, because they disassemble and reassemble the outside corner of the eye while shortening the lower lid.

Canthoplasty may be appropriate for certain post traumatic situations, or when the lower lid has become lengthened with age, but I do not find that it will satisfy patients who want a more youthful look.

Lateral canthopexy, on the other hand, is the surgical repositioning of the lateral canthus—that outside corner of the eye where the eyelids meet. The lateral canthus is moved outward and pexed to the lateral orbital rim. By restoring a “normal” eye shape, lateral canthopexy makes the eye more youthful.

Lateral canthopexy is fundamental to altering or restoring a more youthful shape. Lateral canthopexy may be performed on its own, but many patients combine it with blepharoplasty and/or midface elevation for the most comprehensive anti-aging results.

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