Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
The “fox eye” look, an upturned, elongated, almond-shaped eye appearance popularised on social media and through prominent celebrity faces, has driven a sharp rise in patient enquiries about surgical procedures that modify eye shape. The most commonly referenced procedure is lateral canthoplasty. It’s a real surgical procedure with established uses in reconstructive and functional eye surgery, but the cosmetic application that has become trend-associated is a significantly different proposition that warrants careful clinical thought before any patient considers it.
I’m Dr Scott J Turner, a Specialist Plastic Surgeon (FRACS) at our Bondi Junction and Manly clinics in Sydney. This article is an educational overview of what lateral canthoplasty actually is as a surgical procedure, why it is sometimes combined with brow lift surgery, what the realistic considerations are for patients researching it for cosmetic eye-shape modification, and the regulatory framework that applies to cosmetic surgery in Australia. It is not a marketing piece for the procedure. It is an honest discussion of a procedure that, in my view, requires more careful consultation than many of the patients enquiring about it currently expect.
What Lateral Canthoplasty Is, Clinically
The lateral canthus is the outer corner of the eye, where the upper and lower eyelids meet near the temple. Lateral canthoplasty is a surgical procedure that modifies the position, tension, or anatomy of this outer corner. The procedure has several distinct clinical applications.
Functional lateral canthoplasty is performed to address lower eyelid laxity, ectropion (outward turning of the lower eyelid), or reconstruction following trauma or tumour removal. In these contexts, lateral canthoplasty is a well-established procedure with clear medical indications.
Lateral canthoplasty as part of lower blepharoplasty is performed routinely in many lower eyelid surgeries to support the lower lid and prevent post-operative lid malposition. In this context, it is a supporting technique rather than a standalone procedure.
Cosmetic lateral canthoplasty for eye-shape modification is the application that has become trend-associated. Here, the procedure is performed with the goal of producing a more upturned outer corner of the eye, often as part of what patients describe as a “fox eye” or “almond eye” appearance. This is a different proposition from the functional and supportive uses, and the clinical considerations are different.
Why Brow Lift Is Sometimes Discussed Alongside
The “fox eye” appearance involves not only the eye corner but also a slightly elevated tail of the brow. Some patients seeking this overall look ask about combining lateral canthoplasty with a brow lift, particularly a temporal brow lift that elevates the outer brow.
It is worth being clear that the brow lift and the lateral canthoplasty are two separate surgical procedures with two separate sets of risks, recovery requirements, and considerations. They are not a single combined procedure. Each must be evaluated on its own merits during consultation, and patients considering both should understand they are agreeing to two operations, not one.
For a fuller discussion of brow lift specifically, see our Brow Lift Surgery procedure page.
Why I Am Cautious About Cosmetic Lateral Canthoplasty for Eye-Shape Modification
I want to be direct about my clinical position on this procedure, because it is different from how the procedure is often presented in trend-led media and social content.
The cosmetic application is not a long-established procedure with decades of outcome data. The functional uses of lateral canthoplasty have a long history in oculoplastic and plastic surgery. The cosmetic eye-shape application driven by the recent trend has a much shorter track record, and the long-term outcome data is correspondingly limited.
The risk profile is meaningful. Possible complications include asymmetry between the two eyes (the most common cosmetic concern), changes to the natural eye-shape that the patient may find more or less pleasing than expected, dry eye symptoms, ectropion, scleral show (visible white below the iris), revision surgery requirements, and rarely visual disturbance. These are not theoretical risks; they are known to occur.
The result is permanent. Unlike some non-surgical alternatives, surgical lateral canthoplasty produces a structural change that does not reverse. Revision surgery is possible but is technically more difficult than the primary procedure and has its own risk profile.
The patient demographic raises specific concerns. Most patients currently asking about cosmetic lateral canthoplasty are in their 20s and early 30s. Cosmetic surgery for younger patients warrants particularly careful psychological assessment, and the social media-driven nature of the current demand makes the assessment more important rather than less. AHPRA guidelines specifically address this concern and require psychological screening for cosmetic surgery patients.
The trend may not age well. Patients considering a permanent surgical change to follow a current aesthetic trend should think carefully about whether the trend will still feel like the right choice in five, ten, or twenty years. The structural change does not adjust if aesthetic preferences shift.
For these reasons, I take a careful approach to consultation requests for cosmetic lateral canthoplasty. Many patients who initially ask about the procedure decide, after a thorough discussion of the actual considerations, to take a different path. That is often the right outcome.
Who May Be a Candidate
The candidacy assessment for cosmetic lateral canthoplasty is more involved than for many cosmetic procedures, because of the points above.
Factors that may indicate a patient is a reasonable candidate to discuss the procedure further include: realistic expectations grounded in their own anatomy rather than reference photos of other people, awareness of and acceptance of the risk profile, motivation that is intrinsic rather than driven by social pressure or short-term trend influence, age and life-stage considerations, no untreated body-image concerns, no significant pre-existing dry eye, lid laxity, or related ophthalmic issues that would worsen with the procedure, and willingness to engage with the cooling-off period and second consultation requirements rather than treating them as obstacles.
Factors that may indicate the procedure is not appropriate include: motivation primarily driven by social media or celebrity reference, expectations of a specific result based on photos of other people’s faces, recent emotional or relationship events (the cooling-off period exists in part to protect against this), untreated mental health concerns including body dysmorphia, very young age without compelling individual reasons, and any pattern of seeking multiple cosmetic procedures in a short period.
The candidacy assessment is the consultation, not a checklist that can be completed online. There is no substitute for an in-person clinical discussion.
What the Surgery Involves
For patients who, after consultation, are considered appropriate candidates and who choose to proceed, the procedure involves the following.
Anaesthesia. Lateral canthoplasty for cosmetic indications is typically performed under general anaesthesia or twilight sedation, depending on whether the procedure is combined with other surgery. Anaesthesia carries its own risk profile that is discussed during consultation.
Incision and dissection. A small incision is made at the lateral canthal area, often hidden in or near the natural lid crease or extending slightly into a natural smile line for combined procedures. The lateral canthal tendon, the structure that anchors the outer corner of the eye, is then accessed.
Repositioning. The lateral canthal tendon is repositioned and fixed to a higher and slightly more posterior point on the orbital rim. The exact vector of repositioning depends on the patient’s anatomy and the surgical goal.
Closure. The incision is closed with fine sutures. Depending on the technique, sutures may be removed after approximately one week.
Recovery. Initial swelling and bruising are expected and generally settle over two to three weeks. Final results are not assessable until tissues have fully settled, typically several months after surgery. Activity restrictions, eye protection, and follow-up review are important during the recovery period.
Combining with Brow Lift
Patients considering both lateral canthoplasty and a brow lift should be aware that combining the two procedures means a longer operation, a more involved recovery, additional risk exposure, and additional cost. Each procedure must be justified on its own merits during consultation, and the combination should be a considered decision rather than a default.
For some patients, a temporal brow lift alone produces a sufficient change to the outer eye area and lateral canthoplasty is not required. For other patients, lateral canthoplasty alone addresses the specific anatomical concern. For others again, neither procedure is appropriate. The consultation determines which path, if any, is right.
For more on brow lift specifically, see our Brow Lift Techniques guide.
Non-Surgical Alternatives Sometimes Discussed
Some patients researching the “fox eye” trend ask about non-surgical alternatives such as thread lifts, brow-area filler, or temporal cosmetic injectables. These options have different considerations from surgery.
Threads in the temporal area have a poor safety record in this region and are not something I offer. The complication profile in the lateral periorbital area is significant and the duration of effect is short relative to the risk taken.
Filler-based attempts to mimic the fox eye look are technique-dependent and operator-dependent, and like all filler interventions in the periorbital area, carry the risk of vascular complications including, very rarely, visual loss. Filler is not a “no-risk” alternative to surgery; it is a different set of risks with a different time profile.
Cosmetic injectables can produce a subtle elevation of the brow tail in some patients but cannot meaningfully change the position of the lateral canthus. They are best understood as a complementary option rather than an alternative to surgical eye-shape modification. Cosmetic injectables are a prescription medical treatment and should only be administered by a registered medical practitioner following appropriate consultation.
The Regulatory Framework for Cosmetic Surgery in Australia
Cosmetic surgery in Australia is regulated by the Medical Board of Australia and AHPRA. Several requirements apply specifically to cosmetic surgery and are not optional.
A GP referral is required before a patient can have an initial consultation for cosmetic surgery. This requirement exists to ensure that patients have spoken with their primary medical practitioner about their motivations and any underlying concerns before seeing a surgeon.
A minimum of two preoperative consultations is required, with at least one of these conducted in person. The two-consultation requirement exists to give patients the opportunity to consider information between visits and to discuss their decision with their support network.
A minimum cooling-off period of seven days applies between final consultation and surgery for adult patients (and three months for patients under 18, where surgery is permitted at all). This is a regulatory requirement designed to protect against impulsive decisions.
Psychological screening is required, with referral to a registered psychologist or psychiatrist where appropriate. For procedures aimed at modifying appearance to match an aesthetic trend, this assessment is particularly important.
These requirements apply to lateral canthoplasty for cosmetic indications. They are part of the consultation process, not optional add-ons. Patients who experience these requirements as obstacles rather than safeguards may want to consider whether cosmetic surgery is the right path for them at this time.
Risks and Realistic Expectations
All surgery carries risk. Possible complications associated with lateral canthoplasty include but are not limited to: asymmetry between the two eyes, scleral show (visible white below the iris), ectropion (outward turning of the lower lid), changes to eye shape that the patient finds less pleasing than expected, dry eye and irritation, hypertrophic or pigmented scarring, infection, haematoma, alteration to the natural blink dynamics, very rarely vision changes, and the need for revision surgery.
Outcomes vary considerably between individuals based on anatomy, healing characteristics, and the specific surgical technique used. No surgery guarantees a specific aesthetic result. The procedure produces a structural change that may not match the patient’s mental image of the desired outcome, and may not match photos of other patients or public figures.
For a fuller discussion of blepharoplasty-related risk, which overlaps significantly with the risk profile of lateral canthoplasty, see our Risks and Complications of Blepharoplasty Surgery guide.
Frequently Asked Questions
What is lateral canthoplasty?
Lateral canthoplasty is a surgical procedure that modifies the position, tension, or anatomy of the lateral canthus, the outer corner of the eye where the upper and lower eyelids meet. The procedure has multiple clinical applications: functional reconstruction following lower lid laxity or trauma, supportive use during lower blepharoplasty to prevent post-operative lid malposition, and cosmetic eye-shape modification associated with the “fox eye” trend. The functional and supportive uses are well-established. The cosmetic application has become more common recently and warrants careful consultation including discussion of risks, realistic outcomes, and individual candidacy.
Is fox eye surgery the same as lateral canthoplasty?
“Fox eye surgery” is a non-clinical term that has emerged from social media and refers to procedures that produce a more upturned, elongated, almond-shaped eye appearance. The procedures actually performed are lateral canthoplasty (often combined with a temporal brow lift). The clinical procedures are real, with established techniques and known risk profiles. The “fox eye” framing is a marketing description rather than a clinical procedure name. Patients seeking this look should be aware that the underlying surgery is a permanent structural modification with the risk profile discussed earlier in this article.
Am I a good candidate for cosmetic lateral canthoplasty?
Candidacy assessment for cosmetic lateral canthoplasty is more involved than for many cosmetic procedures, given the permanence of the change, the trend-driven nature of much of the current demand, and the demographic profile of typical enquiries. Factors considered include realistic expectations, motivation that is intrinsic rather than driven by external pressure or current trends, age and life-stage, absence of untreated body-image concerns, absence of pre-existing dry eye or lid laxity issues, and willingness to engage genuinely with the regulatory cooling-off period and second consultation requirement. The assessment can only be completed in person during consultation and not from a photograph or online intake form. Many patients who initially enquire decide, after thorough discussion, to take a different path. That is often the right outcome.
What are the risks of lateral canthoplasty?
Possible complications include asymmetry between the two eyes (the most common cosmetic concern), scleral show, ectropion, dry eye and irritation, changes to eye shape that may not match the patient’s expectation, hypertrophic or pigmented scarring, infection, haematoma, alteration to blink dynamics, very rarely vision changes, and the need for revision surgery. Revision is technically more difficult than the primary procedure. Outcomes vary considerably based on anatomy, healing, and surgical technique. No surgery guarantees a specific aesthetic result. Risks are discussed in detail during consultation.
What is the cooling-off period for cosmetic surgery in Australia?
Australian regulation requires a minimum seven-day cooling-off period between the final preoperative consultation and surgery for adult cosmetic surgery patients. For patients under 18, where cosmetic surgery is permitted at all, the cooling-off period is three months. The cooling-off period is mandatory and exists to protect against impulsive decisions about permanent surgical changes. It is part of the regulatory framework administered by the Medical Board of Australia and AHPRA.
Next Steps
If you have read this article and are considering whether lateral canthoplasty might be appropriate for you, the next step is to obtain a GP referral and book an initial consultation at our Bondi Junction or Manly clinic. Cosmetic surgery in Australia requires a GP referral, two preoperative consultations, psychological screening where appropriate, and a cooling-off period in line with AHPRA guidelines. Related procedure information is available on the Lower Blepharoplasty and Brow Lift procedure pages.
Contact our clinic for general enquiries on 1300 437 758 or email [email protected].
General information only, not medical advice. All surgery carries risk. Outcomes vary considerably between patients based on anatomy, skin quality, health factors, and individual response to surgery. Any decision about cosmetic surgery requires individual clinical assessment by a qualified health practitioner.
