Canthopexy: everything you need to know about this eyelid surgery

The eyes define a large part of facial expression and of the image we project to others. When, over time, the look becomes duller and less radiant, the face can take on a harsher, more tired appearance. Fortunately, technological advances now make it possible to minimise the effects of time around the eyes, in particular thanks to blepharoplasty. That said, it is not the only procedure aimed at modifying the eye contour. Canthopexy, for its part, is not designed to rejuvenate the eyes but to give them an altogether different look — finer and more mysterious — in keeping with current aesthetic standards. Here is everything you need to know about this eyelid surgery, which offers the possibility of changing the overall appearance of the eyes to make them more alluring.

What is canthopexy?

Canthopexy is first and foremost a procedure with a purely cosmetic purpose, aimed mainly at young women who want to enhance their eyes. Technically, it consists of tightening and re-fixing the lateral canthal tendon — the angle where the upper and lower eyelids meet — without cutting it, which makes it a supportive rather than a reconstructive procedure.

Who is this eyelid surgery for?

The canthopexy procedure, also known as the “cat eyes” or “Fox Eyes” look, is performed overwhelmingly on women, most often aged 20 to 40. The terms cat eyes and Fox Eyes refer to the shape of these animals’ eyes, which take on an almond shape with an outward stretch of the eyes. Changing these proportions is intended to feminise the eyes and give them a “striking gaze”. This feature is reminiscent of a certain Bella Hadid, a Western beauty standard who inspires many women considering the procedure, which is sometimes also referred to as the “Bella eyes procedure”.

While demand comes mainly from young women, canthopexy in men is entirely possible: it then aims more to reinforce a drooping gaze or to correct laxity at the outer corner of the eye, in a supportive rather than markedly transformative approach.

The goals of canthopexy

The main goal of the procedure is to stretch the eyes outward so that the corners appear pointed and slightly raised. This tapered shape reduces the white of the eye, leaving no white space at the top or bottom so that the iris is not fully exposed. Canthopexy thus softens the eyes while giving them character. It also produces a lifting effect at the edge of the eyes, at the corner of the eyelid, eliminating any potential drooping effect, whether present naturally or following skin sagging.

Canthopexy or canthoplasty: what’s the difference?

These two very similar terms are often confused, but they cover two quite distinct procedures. Canthopexy simply tightens and repositions the lateral canthal tendon without cutting it: it is a supportive, minimally invasive technique that does not alter the overall structure of the eye. Canthoplasty, by contrast, goes further: it involves a reconstruction of the canthus, cutting and shortening the canthal tendon of the lower eyelid, which is then re-attached to the lateral orbital rim. Here, the term “-plasty” refers to a radical modification of the structure of the orbital area. Canthoplasty therefore addresses corrective indications (significant laxity, sequelae, marked asymmetry), whereas canthopexy remains the procedure of choice for a simple cosmetic lift of the corner of the eye. Canthopexy also allows the women who undergo it to simplify their make-up routine.

The techniques used during the procedure

Two different techniques can be used for canthopexy: the thread lift method or the surgical technique.

The first consists of using tensor threads to keep the corners of the eyes raised. These are generally placed in a triangle, running from the scalp to the tail of the eyebrows. The threads apply traction that holds in place the raised almond shape the eyes have taken on. They anchor to the subcutaneous tissue using micro-barbs (barbed threads) and lift the tail of the eyebrow for a deeper, more “feline” gaze. The threads used can be absorbable or non-absorbable, which determines whether the result is temporary or permanent.

The surgical method, for its part, amounts to repositioning and re-tensioning the lateral canthus (the notch where the eyelids meet) to stretch the corner of the eye and prevent the drooping effect. It aims to reverse the triangle of the face, which tends to sag with age, and thus to reverse the direction of gravity to lift the eyes and make them livelier and more mysterious.

Canthopexy: the procedure itself

Canthopexy is a relatively minor surgical procedure, both in how it is carried out and in the post-operative recovery observed, which tends to be fairly mild. Even so, it still requires standard preparation.

Before the procedure

Before canthopexy surgery, as with any plastic surgery procedure, the practitioner will give you a few instructions to follow. Generally, these focus on stopping smoking if you are a smoker, one month before the procedure. You will also be advised to avoid taking aspirin and any other anticoagulant medication during the 10 days before the procedure. If you do take such medication, tell your doctor. During the pre-operative consultations, the surgeon gathers your goals and guides you toward the most appropriate type of procedure. An appointment with the anaesthetist is also mandatory at least 48 hours before the procedure.

The details of the procedure

The canthopexy procedure differs depending on whether you opt for the thread lift technique or the surgical method.

For the thread lift technique

After local anaesthesia, the surgeon makes incisions to within a millimetre that are no larger than a pencil lead (about 0.5 mm). In practice, PDO (polydioxanone) threads are then placed in the subcutaneous tunnels leading to the scalp. It is there that the fixation is performed, applying a traction force on the lateral canthus and lifting the corner of the eye. The amount of traction is determined by the quantity of thread used and by its positioning.

The hair helps conceal any trace of the fixation. Discomfort is relatively limited thanks to the length of the tunnels, anaesthetised locally, which mask the sensations very well. If absorbable threads are used, the result will be temporary, lasting 6 to 9 months. If they are non-absorbable, fibrosis forms and the result is generally permanent. The procedure usually lasts 45 to 60 minutes and can sometimes be carried out in the practitioner’s office.

For the surgical method

This is a procedure performed under local anaesthesia with sedation, or under general anaesthesia for greater comfort, during which the surgeon makes a one-millimetre incision in the eyelid crease to access the lateral canthal tendon. The procedure then consists of repositioning this tendon higher and fixing it to the orbital rim so that the lateral canthus sits above the medial canthus. Once the lateral canthus has been repositioned permanently, absorbable threads are used to close the incision. The scar, placed within the folds of the eyelid, is then very discreet. The duration of the procedure is fairly variable, ranging from 30 minutes to 2 hours. The procedure can be performed on an outpatient basis, with discharge on the evening of the operation.

The post-operative recovery

Canthopexy is a relatively minor procedure with very few risks and post-operative complications. Nevertheless, after the procedure you will need to rest for a few days. During this time, bruising and swelling may occur. Ocular disturbances may persist for a few days (greater sensitivity of the eyes, asymmetry, watering, blurred vision, tension in the eyelids, and so on).

If you exercise regularly, you will need to allow about two weeks before resuming this activity regularly. During the first 48 hours after the procedure, strenuous effort should also be avoided. It is indeed advisable to rest as much as possible in the 2 days following the procedure and to avoid sudden exertion. Time off social life remains short: most patients return to a normal life within one to two weeks, once the bruising has subsided.

The risks and complications of canthopexy

Like any surgical procedure, even a minor one, canthopexy is not entirely without consequence and carries certain risks and complications that should be understood and discussed with your surgeon before deciding. The most common after-effects remain benign and transient: swelling, bruising at the corner of the eye, discomfort or temporary tension in the eyelid. More rarely, one may observe an asymmetrical look (the two sides not being raised in exactly the same way), an insufficient result or, conversely, an overly pronounced effect, a small haematoma caused by bleeding, or temporary eye dryness linked to momentarily less complete eyelid closure. These complications remain uncommon when the indication is set correctly and the procedure is entrusted to an experienced eye surgeon. The scar, hidden in the eyelid crease or under the scalp, is as a rule discreet and fades over time.

The cost of the procedure

After the first consultation, the surgeon will give you a personalised quote relating to the type of operation planned. The average cost of a canthopexy procedure is around 3,000 euros. The price range is 2,000 to 4,000 euros and depends on the surgeon’s fee. As this is a purely cosmetic procedure, there is moreover no insurance coverage by the French Sécurité sociale, except in rare medical indications. Additional costs are also to be expected. In particular, you will need to factor in the cost of the consultation with the specialist surgeon, which is around 100 euros. The anaesthetist may also be paid separately and will likewise be close to 100 euros. Some painkillers may also be needed in case of post-operative pain. These price ranges apply to a “Fox Eyes” or “cat eyes” operation, these terms referring to the same lift of the outer corner of the eye.

The result of the canthopexy procedure

The results of the canthopexy operation are not immediate, owing in particular to the swelling and bruising that follow the procedure. The first effects will be visible about 2 weeks after the procedure, and you will need to wait 1 to 6 months, depending on the patient profile, to see the final result.

How long the result lasts

How long the result lasts depends directly on the technique used. With absorbable threads, the effect remains temporary and generally fades within 6 to 9 months as the threads dissolve; the international literature reports, moreover, that for PDO threads used around the eyes, the average hold is 6 to 18 months depending on skin type, age and lifestyle. With non-absorbable threads or the surgical method, the result is long-lasting, even permanent, because the fibrosis that forms around the threads stabilises the lift over time. A landmark Japanese study on non-absorbable thread lifting (Fukaya, 2017) even observed that the effect, after a slight decrease during the first few months, improved beyond the first year thanks to this fibrous reaction — which explains why the surgical route is more durable.

The alternatives for lifted eyes

Other procedures, some of them even less invasive, can achieve more or less the same results as canthopexy, and to a greater or lesser degree of permanence.

Aesthetic medicine treatments

With aesthetic medicine, the effects are in this case not permanent but will deliver the desired result for around 6 to 9 months. Botulinum toxin injections at the tail of the eyebrow can in particular achieve the Fox Eyes look for a limited time. They are then performed at the tail of the eyebrow. The orbicularis muscles are thus relaxed and the tail of the eyebrow lifted. The tensor effect of a hyaluronic acid injection can also be used to lift this area. These aesthetic medicine techniques have the advantage of not permanently altering the eyes, in case you are no longer satisfied with this fashionable effect in the future. They can also be used to complement surgery. To go further into this trend, our dedicated article on the Fox Eyes eyelid surgery details the various possible approaches.

The other surgical procedures

For a permanent result, however, surgery will necessarily be required. Blepharoplasty can in particular correct the appearance of the eyes. It involves a plastic surgery procedure that works on the lower eyelids to harmonise the eye contour and open up the eyes. Unlike canthopexy, it mainly targets erasing the effects of age on the lower and upper parts of the eyes. You can indeed regain a more youthful look, less tired, brighter and with fewer irregularities. While the result is not entirely the same as that obtained with Fox Eyes, you will still notice a marked change improving your facial expression. To understand how these different techniques combine, you can consult our feature on eye rejuvenation and the eye contour.

Facial fat transfer is another operation that can rejuvenate the eyes and treat unsightly under-eye hollows and bags. It consists of re-injecting the patient’s own fat harvested elsewhere (autologous fat transfer) into the hollows and irregularities to even out the eye contour. When the problem is concentrated on the shadows under the eyes, our article on treating under-eye hollows with plastic surgery reviews the appropriate solutions. For an even more radical result, it is also possible to undergo a facelift aimed at redefining the volumes by removing excess skin and fat to rejuvenate the face.