Canthoplasty is a surgical procedure that reshapes the corner of your eye where the upper and lower eyelids meet. A surgeon cuts and repositions the tendon at the outer (or sometimes inner) corner of the eye, then anchors it to the bone of the eye socket. The goal is either cosmetic, to change the shape or slant of the eye opening, or medical, to correct a drooping or sagging lower eyelid that exposes the white of the eye.
What the Surgery Actually Changes
The canthus is the point where your upper and lower eyelids come together. You have two: a medial canthus (inner corner, near your nose) and a lateral canthus (outer corner). Canthoplasty targets the tendon at one of these corners and physically detaches it, repositions it, and reattaches it to the rim of the eye socket. This changes how wide or narrow the eye opening looks and can adjust whether the outer corner of your eye tilts up, down, or sits level.
Lateral canthoplasty, the more common version, works on the outer corner. It can lengthen the visible eye opening horizontally and lower the outer tail of the eye. This is sometimes called “cat eye surgery” because the result is a longer, more almond-shaped eye with a slightly lifted outer corner. Some patients seek it purely for appearance, while others need it to restore eyelid function after nerve damage or aging.
Medial epicanthoplasty works on the inner corner instead, enlarging the eye horizontally from the nose side. Surgeons sometimes combine both to maximize the change in eye width. While double eyelid surgery changes the vertical dimension of the eyes, canthoplasty operates in the horizontal dimension.
Who Gets Canthoplasty
Candidates generally fall into two groups: people seeking a cosmetic change and people with a medical need.
On the cosmetic side, candidates often feel their eyes appear too narrow or that a steeply angled outer corner gives them an overly harsh expression. When the outer corner of the eye sits noticeably higher than the inner corner, it can create what surgeons describe as a “stubborn or angry” look. Canthoplasty lowers and extends that outer corner to soften the overall impression.
On the medical side, the most common indication is ectropion, a condition where the lower eyelid pulls away from the eyeball and sags outward. Paralytic ectropion, which follows facial nerve damage, is particularly well suited to canthoplasty because the supporting tissues around the outer corner have stretched and loosened. Without correction, the exposed eye surface dries out, tears constantly, and risks corneal damage. The surgical goal in these cases is to shorten the eyelid horizontally, reposition it against the eye, and restore proper tear drainage and eye closure.
Canthoplasty vs. Canthopexy
These two procedures sound similar but differ in how aggressively they reshape the corner of the eye. Canthopexy reinforces the existing structures, typically with sutures or internal fixation, without cutting the tendon. It offers subtle enhancement with less downtime. Canthoplasty actually divides the canthal tendon, repositions it, and reattaches it, which allows for more dramatic and longer-lasting changes.
The tradeoff is that canthoplasty carries a higher risk profile and longer recovery. For mild laxity or a patient who wants only a slight lift, canthopexy may be enough. For significant drooping, noticeable ectropion, or a major change in eye shape, canthoplasty is the stronger intervention.
How the Procedure Works
Canthoplasty can be performed under general anesthesia or local anesthesia with sedation. The surgeon makes a small horizontal incision, typically about 5 millimeters, starting from the outer corner of the eye. This may be joined with a subciliary incision (just below the lash line) if a lower blepharoplasty is being done at the same time.
The incision is deepened to expose the lateral canthal tendon and the tarsal strip, a firm band of tissue at the edge of the eyelid. The surgeon then divides the lower portion of the canthal tendon from the upper portion, which frees the outer corner for repositioning. The conjunctiva (the thin membrane lining the inside of the eyelid) is separated from the tarsal plate so the corner can move freely. Excess skin, muscle, and conjunctiva are trimmed away. Finally, the repositioned tendon is sutured to the periosteum, the tough tissue covering the bone at the outer rim of the eye socket. This anchoring point determines the final position and angle of the eye corner.
Recovery Timeline
Expect noticeable swelling and bruising around the eyes for the first one to two weeks. Most people report that the worst of the swelling peaks around day three or four and then gradually improves. Sutures are typically removed within seven to ten days. You can usually return to desk work and light daily activities within one to two weeks, though strenuous exercise and anything that raises blood pressure to the face should wait longer.
The eyes will continue to settle over several weeks to months. Early on, the eye shape may look overcorrected or slightly asymmetric due to swelling, so the final result takes patience. Cold compresses, keeping your head elevated while sleeping, and avoiding rubbing or pressing on the eye area all help during the initial healing phase.
Risks and Complications
Complications from eyelid procedures overall are uncommon, but they do occur. In one published series of 200 patients, the complication rate was 9.5%. The most frequent issue was chemosis, a swelling of the membrane covering the white of the eye, which happened in about 6% of patients and was especially common when canthoplasty was involved because of the tissue handling near the conjunctiva. Chemosis is uncomfortable but typically resolves on its own.
Lower eyelid malposition is the complication patients worry about most. This includes retraction (where the lid pulls down too far, exposing a strip of white below the iris) and ectropion (the lid turning outward). In the same series, about 3% of patients had cosmetic complaints from lower lid malposition. The main causes are removing too much skin, unintended scarring of deeper tissue layers, or failure of the anchor point to hold. Revision surgery can correct these problems, often using a different canthoplasty technique or adding a small skin graft.
Other possible complications include hematoma (blood pooling under the skin), asymmetry between the two eyes, scarring at the incision site, and temporary difficulty closing the eye fully.
Cost
Canthoplasty is often performed alongside blepharoplasty (eyelid surgery), and pricing varies widely by surgeon, region, and whether the procedure is standalone or combined. The American Society of Plastic Surgeons lists the average cost of cosmetic lower blepharoplasty at $3,876, which provides a rough reference point, though canthoplasty as an add-on or standalone procedure may be priced differently depending on the practice.
Cosmetic canthoplasty is generally not covered by insurance. However, when the procedure is medically necessary, such as correcting ectropion that threatens corneal health or impairs eyelid closure, insurance may cover part or all of the cost. Documentation of functional impairment is typically required for approval.