Will Canthopexy Help Eyes Made Too Small After Lower Eye Lift?

Had lower eye lift then 6 weeks later fractional co2 laser. Now 1 year out of surgery the outer corners of my eyes are too tight and lower lids pulling down, making eyes small and rounded. Ps has suggested a canthopexy, I am very worried as this will make my eyes smaller. Would very much appreciate your views.

Doctor Answers 6

Consult with oculoplastic surgeon RE: canthopexy

It is best to seek out a consultation from an oculoplastic surgeon regarding a canthopexy. If done properly, it should not make your small eyes any smaller. The idea is to pull the lower lids upwards and outwards so as to not have a saggy lower lid.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Correcting pulled down eye shape with a canthopexy or cheeklift

Correcting postoperative unfavorable eye shape is a complex problem.  The old paradigm of just doing a canthopexy for an unfavorable postoperative lower eyelid shape is antiquated.  A canthopexy alone can yield a still centrally rounded eye with a severe upturn on the sides where the canthopexy is strongest.

More often than not, a cheeklift may be required to elevate the cheekpad and "give" tissue to the lower eyelid, thus enabling an eye shape correction to a more almond shape.  This is often combined with one of the many forms of canthopexy or canthoplasty.  This can often improve or correct the rounded eye appearance or the pulling down in the corner of the eye.

Many plastic surgeons specialize in the midface and cheek surgery, and have been very innovative in the literature.  Your next move is a very critical one, so spend time researching carefully.

Several articles and book chapters we have written are referenced below.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

A canthopexy is most likely going to be disappointing.

"If you are a hammer then the world looks like a nail."  Unfortunately the canthopexy may be the only canthal/lower eyelid repair surgery your surgeon is familiar with.  However, a canthopexy only "supports" a lower eyelid.  When the lid has been compromised by surgery and laser resurfacing, it is often necessary to resort to more powerful corrective measures.  

I would recommend to look to identify eye plastic surgeons who devote a significant part of their practice to repairing unsatisfactory eyelid surgery.  This will take some research on your part.  Honestly there are a limited number of individuals who do this type of work and it is generally worthwhile to traveling to the right surgeon.  Photo of you situation might make it possible to be more concrete regarding what you need. 

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Canthopexy helps to support the lower eyelid

Canthopexy is used to support the lower eyelid and it is one way to treat horizontal laxity.  I doubt that it would provide benefit in your case, but not enough information is provided to make that determination.  A repeat visit with your operating surgeon is necessary and you should ask why this happened, what the various alternatives are that will improve your condition, etc.  If you are confused or disagree then you should see another surgeon for a second opinion.  Do not make a decision based on advice given over the internet.  You must be personally examined.

Jack A. Friedland, MD
Phoenix Plastic Surgeon
4.0 out of 5 stars 4 reviews


In  that the canthopexy is designed to tighten the sagging lower lid, it will probably shorten the vertical height of the orbital aperture making it appear smaller although it might also elongate the horizontal aperture making the eye look wider..

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Small eyes

We need more information to help with your question, and we need photos too.  You may have had a lower blepharoplasty via a skin incision, and often times this can result in the lower lids getting pulled down afterwards.  Maybe you see the white of your eyes now in between the lid margin and the colored part of your eyes, where you didn't (and usually shouldn't) beforehand.  In these situations, the outer corner of the lids can become more rounded and the horizontal diameter can sometimes be reduced.

Your plastic surgeon may be able to correct these issues with a canthoplasty/pexy alone, or it may require something more complicated.  I would make sure he/she is an expert at eyelid surgery, as you've already had one surgical procedure, and are about to have a second.  Each time you have more surgery, there is more scar tissue introduced, and potential damage to the nerves that control the eyelid muscles.  So you want to make sure you give it your best shot, and that means going to the best eyelid surgeon- someone known for correcting cosmetic eyelid surgery problems (or at least willing to offer a guiding second opinion to your plastic surgeon).

Good Luck.

Yoash R. Enzer, MD, FACS
Providence Oculoplastic Surgeon
3.4 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.