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Canthoplasty: Understanding the Procedure and its Applications

Canthoplasty is a surgical procedure that reconstructs the lateral canthus (outer eye corner) to correct eyelid malposition, improve function, or enhance aesthetics. It involves detaching and reattaching the lateral canthal tendon (LCT) to the periosteum of the lateral orbital rim.

Indications

  • Ectropion: Outward-turning lower lid (laxity, paralysis, scarring).
  • Entropion: Inward-turning lid (laxity, spasm, scarring).
  • Lower Lid Retraction: Post-blepharoplasty, thyroid eye disease, trauma.
  • Lateral Canthal Dystopia: Asymmetric canthal position.
  • Paralytic Lagophthalmos: Facial nerve palsy (combined with gold weight).
  • Cosmetic: Canthopexy for lateral lift ("cat-eye" appearance).

Procedure Overview

  1. Local anesthesia with sedation or general anesthesia.
  2. Incision at lateral canthus (or transconjunctival).
  3. Lateral canthal tendon (LCT) released from Whitnall's tubercle.
  4. LCT repositioned superiorly, posteriorly, and/or medially as needed.
  5. Secured to periosteum of lateral orbital rim with permanent suture (drill hole or suture anchor).
  6. Lid margin apposition verified; skin closed.

Canthopexy vs. Canthoplasty

  • Canthopexy: LCT tightened/suspended without detachment; less invasive, for mild laxity.
  • Canthoplasty: LCT fully detached and reattached; stronger correction for significant malposition.

Recovery

  • Swelling, bruising: 1–2 weeks.
  • Sutures removed at 5–7 days (if external).
  • Antibiotic ointment, cold compresses, head elevation.
  • Avoid strenuous activity 2 weeks.
  • Final lid position stabilizes over 3–6 months.

Risks

  • Infection, bleeding, scarring.
  • Over/under-correction (lid too high/low, rounding of canthus).
  • Lid margin notching, trichiasis.
  • Asymmetry.
  • Corneal exposure if over-elevated.

Outcomes

Functional canthoplasty (for ectropion, retraction, paralysis) has high success rates. Cosmetic canthoplasty requires careful patient selection and realistic expectations. Choose a surgeon with oculoplastic fellowship training (ASOPRS).

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