Surgical · eyelid
Canthoplasty and canthopexy
Two related operations on the outer corner of the eye. They change a millimetre or two of tendon position, and the eye is the least forgiving place on the face to be a millimetre off.
Not medical advice. This page explains what a procedure is and what is known about it. It is not a recommendation, and it says nothing about whether you are a candidate for anything. Only a licensed provider who has examined you can tell you that.
What it maps to in LooksRatio
- Canthal tiltthe angle from the inner corner of the eye to the outer corner
What it is
The lateral canthal tendon anchors the outer corner of the eyelids to the bone of the orbital rim. Where that anchor sits determines the tilt of the eye.
A canthopexy tightens and repositions the existing tendon without detaching it. A canthoplasty detaches it and reattaches it at a new point, which is the more powerful and less reversible of the two. Canthopexy is generally enough for mild laxity; canthoplasty is for a genuine change of position or significant laxity.
How it works
Through a small incision at the outer corner, the tendon is exposed and fixed to the periosteum inside the orbital rim at a higher point than it sat before. Raising the anchor raises the outer corner, which is what produces a positive tilt.
The procedure is very often done as support alongside a lower blepharoplasty rather than on its own, because lower eyelid surgery can pull the lid downward and canthal support is what prevents that.
Recovery
Bruising and swelling at the outer corner for one to two weeks. The final position takes months to settle, and early results commonly look higher than the result you keep.
Risks and what actually goes wrong
In a series of 400 patients having canthopexy with blepharoplasty, complications were relapse of the corrected position in 4%, temporary hematoma in 3%, epiphora (persistent watering) in 3%, unequal eyelid position in 2%, and conjunctivitis or chemosis in 1%.
The named risks of the more aggressive canthoplasty are ectropion (the lid turning outward away from the eye), asymmetry, visible scarring, and over or undercorrection. Asymmetry deserves particular weight here: two eyes are looked at together, and a difference small enough to be invisible anywhere else on the face is obvious between them.
Lower-commitment alternatives
There is no non-surgical way to move the canthus. What can change how the tilt reads without touching it are brow position and the fullness of the lower lid, and both are worth looking at first, because they alter the impression this measurement is trying to capture.
What LooksRatio assumes
The projection moves canthal tilt 80% of the way to its ideal. Note that LooksRatio scores canthal tilt against a single band for every profile, because there is no clean male and female anchor pair for it. It is also a measurement that head tilt in the photo can distort, so a reading well away from your usual is worth re-taking before acting on.