What is a canthopexy?
A canthopexy is surgery that tightens and repositions the lateral canthus —the outer corner where the upper and lower eyelids meet— to restore support to the lower eyelid and, when sought, to lift that corner subtly. It is done by reinforcing the canthal tendon, not cutting it.
With age, or after a poorly planned blepharoplasty, the lower eyelid loses tension and drops: scleral show appears (white visible below the iris), the gaze looks tired or sad, and in marked cases the lid margin pulls away from the eye. Canthopexy corrects or prevents that droop by re-anchoring the outer angle to the bony orbital rim.
It should be distinguished from canthoplasty, with which it is often confused. In a canthopexy the tendon is reinforced and suspended with a suture, without cutting it — a more conservative procedure. In a canthoplasty the tendon is cut, shortened and reinserted, and is reserved for greater laxity. Which one applies is decided by how much real laxity the eyelid has, not by fashion.
It is also requested for aesthetic reasons: a more almond-shaped gaze with the outer corner slightly raised. That is legitimate, but it has limits: canthopexy works on a real tendon and cannot take the eye to any angle without looking artificial. An honest expectation is half of a good result.
Techniques Dr. Arístides Arellano uses
Dr. Arístides Arellano chooses the technique by the cause and the degree of laxity, not the other way around. These are the ones he uses:
- Suspension (reinforcement) canthopexy — a suture is passed through the lateral canthal tendon and fixed to the periosteum of the orbital rim, without cutting the tendon. It is the most conservative and the most common.
- Canthopexy alongside lower blepharoplasty — when skin or fat is removed from a lower eyelid that already has little tension, adding a canthopexy prevents the retraction and ectropion that operation can otherwise cause. This is one of its most important indications.
- Adjustment to vector and canthal tilt — the fixation point is planned to respect, or gently correct, the eye's natural tilt, avoiding a pulled look.
- Referral to canthoplasty — when laxity is large and suspension is not enough, canthoplasty is proposed rather than forcing a canthopexy that would not hold. Saying so in time is part of the technique.
How is it done?
A canthopexy is usually performed under local anaesthesia, with or without sedation, as a day case: the patient walks in and out the same day. On its own it takes about 30 to 60 minutes; longer if combined with blepharoplasty or a facelift.
Through a small incision in the outer eyelid crease or at the corner of the eye, the lateral canthal tendon is identified and a suture suspends it and fixes it to the periosteum of the orbital rim, at the point that restores correct tension and height. Because the tendon is not cut, the scar is short and hidden in a natural fold.
The design is done before anything is touched, with the patient seated and holding a mirror, marking the intended height and angle. A millimetre too much or too little shows in the gaze, which is why planning matters as much as execution.
When combined with a facelift or a blepharoplasty, the canthopexy is often the step that protects the result of the rest: it holds the eyelid so the tightened skin does not drag it downward.
All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.
Who is a good candidate?
Canthopexy is for someone with lower-eyelid laxity —either their own or to prevent a problem during surgery— not for anyone who simply wants to lift the gaze. A good candidate is usually:
- Someone with lower-eyelid laxity and a slow snap-back (the lid is slow to return when pulled away from the eye).
- Someone about to have a lower blepharoplasty on a lax eyelid, where canthopexy prevents retraction.
- Someone with scleral show or a mild-to-moderate droop, without an established frank ectropion.
- Someone with a negative vector (the eye prominent relative to the cheekbone), where removing lid skin without support would be risky.
- Someone seeking an almond-shaped gaze with realistic expectations and no active eye disease.
- Not a good candidate: someone with severe laxity that needs a canthoplasty, significant dry eye, active eye disease, or expectations of changing the shape of the eye that the anatomy does not allow; in those cases it is said plainly.
Recommended follow-up care
After a canthopexy, care of the eye area —cold compresses, not rubbing the eyes, sleeping with the head elevated and sun protection— speeds the settling of swelling and protects the scar. See the full guide: Post-surgical recovery and care.
Before and after
Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.
Approximate price
The cost of a canthopexy is defined at your consultation: it depends on whether it is performed alone or combined with a lower blepharoplasty or other facial surgery, and on the degree of eyelid laxity. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano. See the price list.
About Dr. Arístides Arellano
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Related patient guide
Before deciding on any surgery around the eye, it helps to know what to look for when choosing who operates on you. Read how to choose a plastic surgeon in Puebla. If your aim is to rejuvenate the midface or the whole face, review the facelift as well.
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
Recovery · step by step
- Day 0Day-case surgery under local anaesthesia, 30 to 60 minutes on its own. A cold compress is applied and you walk out the same day.
- Days 1–3Swelling and bruising at the outer corner of the eye, sometimes with a red eye-white (chemosis). Cold compresses, head elevated for sleep, and no rubbing of the eyes.
- Days 5–7Sutures are removed. A feeling of tightness at the corner is normal and eases off.
- Weeks 2–3Most of the bruising and swelling resolves; many patients return to social life. A slight temporary asymmetry between the two eyes can persist.
- Weeks 4–6Rubbing the eyes, swimming and strenuous effort are avoided until discharge. Contact lenses are resumed when the surgeon allows.
- Months 2–3The scar pales and the angle settles into its final position. This is when the result is judged. Results may vary from patient to patient.
Frequently asked questions
What is the difference between canthopexy and canthoplasty?
A canthopexy reinforces and suspends the lateral canthal tendon with a suture, without cutting it; it is more conservative. A canthoplasty cuts, shortens and reinserts the tendon, and is reserved for greater laxity. Which one applies depends on how much tension your eyelid has lost, not on fashion, and it is decided at the consultation.
Will a canthopexy give me cat eyes or change the shape of my eyes?
It can subtly lift the outer corner and give a more almond-shaped gaze, but it does not change the shape of the eye at will. It works on a real, anatomical tendon; taking the angle beyond what your anatomy allows looks artificial. With realistic expectations the result is natural, and that is the goal.
Can it be done alone, or does it always go with blepharoplasty?
It can be done alone when the problem is lower-eyelid laxity. Very often, however, it is combined with a lower blepharoplasty: on a lax eyelid, canthopexy prevents the retraction and ectropion that the blepharoplasty could otherwise cause. It is an anatomical decision, not a commercial one.
How long is the recovery?
Swelling and bruising at the corner of the eye occupy the first or second week, and sutures come out around day 5 to 7. Most patients return to social life in two or three weeks, with a possible temporary asymmetry. The angle settles and the scar pales by the second or third month.
Is a canthopexy permanent?
It aims to be durable, but not eternal: it re-anchors the tendon to bone for stable support. Over the years ageing continues and laxity can return, especially where there was a lot to begin with. In large laxity, a canthoplasty holds better than a forced canthopexy. Results may vary from patient to patient.
What are the risks?
Like any surgery, it carries risks: asymmetry between the two eyes, over- or under-correction, a red eye-white (chemosis), a temporary dry-eye sensation, or a rounded or pulled look to the angle if the fixation is not right. A good indication and careful planning reduce them. All surgery requires a prior medical assessment.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.