Canthoplasty: surgery to tighten the lower eyelid

Canthoplasty is an operation to tighten the lower eyelid. The surgeon opens the outer corner of the eye, shortens the end of the lid and stitches it to the tissue that covers the bone. NHS leaflets say it takes about 45 minutes under local anaesthetic, and that bruising and swelling settle over two to four weeks. In a UK audit of 557 operations, 9% were followed by a second operation.

What is canthoplasty?

Canthoplasty is an operation at the outer corner of the eye, where the upper and lower eyelids meet. It tightens a lower eyelid that has become loose.

The most widely used form is the lateral tarsal strip, first described in 1979. The surgeon opens the outer corner, frees the lower lid, shortens it and stitches it to the tissue that covers the bone at the rim of the eye socket. NHS leaflets describe it as tightening the lower eyelid.

Canthopexy is a lighter operation. The tendon at the outer corner is tightened without cutting the corner. Surgeons generally keep canthoplasty for lids that are more loose.

A different operation with the same name is done in East Asia to make the eye opening longer. This page does not cover it.

Who is it for?

The usual reasons are medical:

• Ectropion. The lower lid droops or turns outwards. The NHS lists a sore, red, watery or dry eye among the symptoms.
• Entropion. The lid turns inwards and the eyelashes rub the eye.
• Facial palsy. Weakness of the face, as in Bell's palsy, can cause ectropion.
• After eyelid surgery. It is often part of the repair when cosmetic surgery has pulled the lower lid down.

It is also done during cosmetic lower-eyelid surgery (blepharoplasty) when the lid is already loose, to stop the lid being pulled down afterwards.

To judge how loose the lid is, the surgeon pulls it gently away from the eye and watches how it springs back.

If your reason is cosmetic, expect a small change. One study that measured the result found the outer corner 0.81 mm higher, on average, at the last check. The NHS says that the results of cosmetic eyelid surgery cannot be guaranteed, and that it is a good idea to talk to a GP first.

How the operation is done

The British Oculoplastic Surgery Society says the operation can be done under local anaesthetic and takes about 45 minutes. Complex cases may need a sedative as well. It is usually a day case.

1. Local anaesthetic is injected into the eyelid. The injection is uncomfortable. The operation itself is not painful.
2. A cut of about 5 to 10 mm is made at the outer corner.
3. The corner is opened and the lower lid is freed.
4. The end of the lid is trimmed to a strip and shortened to the right length.
5. The strip is stitched to the tissue that covers the bone at the rim of the eye socket.
6. The corner is re-formed and the skin is closed.

The steps are those described by the surgeons in a UK audit of 557 operations. Blood-thinning tablets may have to be stopped before the operation, but only if your surgeon advises it.

Recovery timeline

Looking after the eye

• Do not rub, poke or press on the eye.
• Wipe with a clean tissue each time, not a handkerchief.
• Put in drops or ointment without pulling on the lower lid.
• Simple pain relief such as paracetamol is usually enough.
• Sleep with your head propped up on two or three pillows.
• For two weeks, avoid heavy lifting and bending with your head below your waist.

Washing. Advice differs between hospitals. Cambridge University Hospitals says you can shower normally and pat the wound dry. The Royal Free says to keep the wound dry for the first week.

Work. Cambridge says you can return within a few days. Leeds Teaching Hospitals says to plan for up to one week off if your job involves heavy lifting or an unclean environment.

The outer corner is commonly tender for several weeks.

Risks and how often they happen

NHS leaflets list these risks:

• swelling and bruising, which are common
• bleeding, infection or scarring
• the problem coming back, or the lid being set too tight or too loose, so that more surgery is needed
• a tender spot at the outer corner, in as many as 15% of patients
• a tender lump at the wound (a granuloma), which is rare and usually goes on its own
• an allergic reaction to the anaesthetic or the drops, which is rare
• loss of vision, which is very rare: less than 1 in 20,000 cases

Watering may continue after a successful operation, because other eye problems can also cause it.

The largest UK audit covers 557 operations at Bristol Eye Hospital and the Royal Eye Infirmary, Plymouth. The average age was 76 and the average follow-up was 13 months.

The authors called the complications relatively minor. These operations were done for medical reasons. We found no UK figures for cosmetic canthoplasty.

When to get help. The Royal Free says to call the eye department if:

• bleeding does not stop after 30 minutes of pressure on the wound
• the wound has come open
• the eyelid becomes very red, warm and tender, or there is pus
• you lose vision, and it is not the blur from the ointment
• you have severe pain that painkillers do not control

Alternatives

• No treatment. The NHS says mild ectropion may not need any.
• Eye drops or ointment soothe the eye and stop it becoming dry.
• Taping the eyelid can protect the eye. An eye specialist shows you how.
• Botulinum toxin injection for entropion. University Hospital Southampton says the effect lasts two to three months.
• Stitches alone for entropion. They take about 30 minutes and work for most people (80%), but are not suitable if the lid is very lax.
• Canthopexy, when the lid is only a little loose.

Cost and NHS funding

NHS. The NHS says you may need surgery if ectropion causes severe symptoms. See a GP, who may refer you to an eye specialist. Cosmetic surgery is not routinely provided on the NHS.

Private. No partner clinic publishes a price for canthoplasty by name. Sapphire Eye Care lists correction of lower lid ectropion, and of lower lid entropion, from £2,534. Its price list does not say which operation that covers, so ask the clinic for a written quote for your own case. Payment terms are set by each clinic, so ask for them in writing before you book.

If you are looking in England, the NHS says to check the Care Quality Commission (CQC) website for clinics that can perform eyelid surgery.

Questions and answers

Sources

Every clinical statement on this page comes from the sources below. They were read on 27 September 2026.

1. Ectropion, NHS — symptoms, causes, treatment without surgery, when surgery is offered
2. Ectropion, British Oculoplastic Surgery Society — anaesthetic, length of the operation, eye pad, check-up
3. Entropion of the upper and lower eyelids, British Oculoplastic Surgery Society — what the operation for entropion involves
4. Lateral tarsal strip: patient leaflet, West Suffolk NHS Foundation Trust — what the operation is, tenderness afterwards
5. Ectropion correction: patient information, Cambridge University Hospitals NHS Foundation Trust — anaesthetic, aftercare, risks, scar, final check
6. Entropion and ectropion repair: post operative advice, Leeds Teaching Hospitals NHS Trust — aftercare, time off work, bruising and swelling, risks
7. Post operative care for eyelid surgery, Royal Free London NHS Foundation Trust — the first days, driving, what to avoid, when to get help
8. Lower lid entropion: patient information, University Hospital Southampton NHS Foundation Trust — alternatives for entropion
9. Vahdani K and others. Lateral tarsal strip versus Bick's procedure in correction of eyelid malposition. Eye 2018;32:1117-1122, PubMed Central — steps of the operation, UK results and complication rates
10. Reggie SN and others. Simple incisionless temporary stabilization: an adjunct to lower blepharoplasty. Aesthetic Surgery Journal Open Forum 2024;6:ojae014, PubMed Central — canthopexy and canthoplasty compared, tests of lid looseness
11. Kopecky A and others. The role of the lateral tarsal strip procedure in modern ophthalmic plastic surgery. Frontiers in Ophthalmology 2022;2:871964, PubMed Central — history and uses of the operation
12. Ramesh S and others. Long-term follow-up of lateral canthal resuspension. Asia-Pacific Journal of Ophthalmology 2018;7:90-94, PubMed record 29480654 — measured change in the position of the outer corner
13. Kim YJ and others. Cosmetic lateral canthoplasty. Archives of Plastic Surgery 2016;43:316-320, PubMed Central — the different operation of the same name
14. Is cosmetic surgery available on the NHS?, NHS — NHS funding of cosmetic surgery
15. Eyelid surgery, NHS — advice before cosmetic eyelid surgery
16. Our prices, Sapphire Eye Care — the partner clinic's published prices