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Combination

Blepharoplasty with canthopexy / canthoplasty

Canthopexy is a small but technically important addition to lower blepharoplasty in many cases — and a critical safety step in others. Understanding when it's needed and when it isn't matters.

Doç. Dr. Ayhan Işık Erdal
Doç. Dr. Ayhan Işık Erdal Associate Professor of Plastic Surgery
MD · FACS · FEBOPRAS · Associate Professor
✓ Medically reviewed · Last updated: May 18, 2026

What canthopexy does

The outer corner of the eye is supported by the lateral canthal tendon — a band of fibrous tissue anchoring the lid edge to the bone. With age (and especially after surgery that disturbs the lid support structures), this tendon can stretch, causing:

  • Lower lid descent — "scleral show" (white visible below the iris)
  • Lid laxity — the snap-back test becomes slow
  • Rounding of the eye shape — loss of the natural almond contour

Canthopexy tightens the lateral canthal tendon by anchoring it firmly to the orbital bone, preventing or correcting these issues.

Canthoplasty goes further — the tendon is fully detached and re-attached at a higher position. More effective but more involved.

When canthopexy is essential

Canthopexy is essential — not optional — in:

  • Subciliary lower bleph in patients with negative vector anatomy
  • Lower bleph in patients with positive snap-back test (lid laxity)
  • Revision lower bleph after previous over-resection
  • Any case where significant orbicularis muscle is being released

In these scenarios, skipping canthopexy substantially increases the risk of lower lid retraction — the most-feared cosmetic complication of lower bleph.

When it's optional

  • Transconjunctival lower bleph in young patients with elastic lids — canthopexy may not be needed
  • Standard subciliary bleph in middle-aged patients with no lid laxity — canthopexy is a small added safety margin but not strictly necessary

Frequently asked questions

Does canthopexy change my eye shape?

Done properly, no — it preserves your natural canthal angle while adding support. Aggressive canthoplasty can subtly raise the outer corner (a deliberate aesthetic in some cases — 'almond eye' or 'fox eye' technique); standard canthopexy for support purposes is invisible.

Does canthopexy add recovery time?

Minimally — the same surgical access used for the bleph is used for the canthopexy. Some additional swelling at the outer corner for ~1 week, otherwise identical recovery.

Medical disclaimer: This page provides general information about blepharoplasty and reflects the clinical opinions of Doç. Dr. Erdal. It does not constitute medical advice for any individual patient. Results vary; all surgery carries risk. Blepharoplasty in some cases produces irreversible changes to eyelid anatomy. Suitability is determined only through personal consultation with full medical history disclosure.

Not sure if you're a candidate?

Blepharoplasty is most successful when patient anatomy, age, and goals align with what surgery can realistically deliver. Send three facial photos (front, profile, eyes-closed) and Doç. Dr. Erdal will give you an honest, no-pressure suitability assessment before you commit to anything.

Ready to discuss your case?

Doç. Dr. Erdal personally reviews every enquiry. Honest assessment of whether blepharoplasty is right for you, with no pressure to book.

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