Fox Eye Thread Lift or Canthoplasty? How the Options Differ

A fox eye thread lift and a canthoplasty are not two versions of the same treatment. Threads are placed under the skin to pull the skin upwards, and the threads gradually dissolve; the effect is temporary, usually quoted as one to three years.¹ A lateral canthoplasty is an operation on the small tendon that holds the outer corner of the eye, and it changes the length and slant of the eye opening itself.⁵ A third option, a lateral brow or temporal lift, raises the outer part of the brow, which is often where the heaviness has developed.⁶

So the first question is not which method is better, but which structure creates the look you want: the brow tail, the eye corner, or both. Below we compare what each moves, how long it lasts, the reported risks and who tends to suit which.

What creates a “fox eye” look?

A “fox eye” look usually combines a higher outer brow tail, a smooth temple and an outer eye corner that looks slightly elongated and tilted upwards. These come from different structures. The brow tail descends with age through gravity, descent of the fat pad beneath the brow and loosening of a superficial connective tissue layer (fascia) in the temple.⁶ The shape of the eye opening, on the other hand, is set by the tendon at the outer corner and by the eyelids.

If the brow tail has dropped, changing the eye corner will not lift it; if the concern is the shape of the eye opening, lifting the brow will not change it. Our guide on eyelid surgery or brow lift describes a simple mirror check for the brow.

How a fox eye thread lift works and how long it lasts

In a thread lift, medical-grade threads are passed under the skin and used to pull the tissue into a new position; the body absorbs them over time.¹ Around the eyes, threads are also used to lift the brow.⁴ Cleveland Clinic describes the results as subtle and temporary, usually lasting one to three years, with swelling and bruising for up to about five days.¹

The quality of evidence is the main issue. A 2018 systematic review of 12 studies found little or no substantial new evidence on thread lifts since an earlier review in 2006: apart from two studies, the lifting effect showed at best very limited durability, and all positive studies were sponsored by thread manufacturers.² In a meta-analysis of 26 studies of facial thread lifts, swelling was the most common problem (about 35%); satisfaction was about 98% immediately afterwards and 88% in the longer term.³

Studies of brow lifting with threads are small: one retrospective series of 29 patients treated with dissolving polydioxanone (PDO) threads reported 26 satisfied patients and no serious complications, but follow-up lasted only three months.⁴

What canthoplasty and canthopexy change

The outer corner of the eye is held by the lateral canthal tendon. In a cosmetic lateral canthoplasty, the tendon is released through a small incision and fixed in a new position. The aim is to lengthen the eye opening and change its slant.⁵ A canthopexy tightens or repositions the corner without fully releasing it, for smaller changes. The operation, recovery and poor candidates are covered on our almond eye surgery page.

Because the change is structural, it is intended to last, which is the main difference from threads. But the eyelid corner is a delicate area: authors describing cosmetic canthoplasty note that complications or unfavourable results are not uncommon.⁵ Much of that literature comes from East Asian practice, where the usual aim is to lengthen the eye and reduce its slant, which is close to the opposite of a fox eye request.⁵ In one surgeon’s series of 600 patients, most of them having reconstructive surgery, complications were rare and minor (for example temporary chemosis), yet 18 patients needed a further operation within two years for recurrent eyelid malposition or corner deformity.⁷

When the answer is the brow or the temple

If the outer part of the brow has descended, a lateral brow or temporal lift raises it through short incisions in the temple hairline, and an endoscopic brow lift works through several short incisions in the hair.⁶ Unlike threads, the tissues are released and fixed in a new position; about 5 mm of the vertical lift is expected to settle after an endoscopic brow lift.⁶

The most common complications of the endoscopic technique are altered sensation, asymmetry and small areas of hair loss; injury to the nerve that raises the brow is less common, and temporary weakness is far more frequent than permanent paralysis.⁶ Techniques and recovery are described on our brow lift page.

Fox eye threads, canthoplasty and brow lift compared

Fox eye thread lift or canthoplasty: who suits which?

Threads may suit someone who wants a temporary, non-surgical change and accepts that it will fade. In the meta-analysis, dimpling (16% versus 5.6%) and infection (5.9% versus 0.7%) were more frequent over the age of 50 and non-absorbable threads caused more complications, so the authors advise caution in older patients.³

A canthoplasty or canthopexy is considered when the length or slant of the eye opening is the concern⁵ and the anatomy supports it; deep-set eyes or a lax lower eyelid make results less predictable. A brow or temporal lift usually suits a descended brow tail with an otherwise fine eye shape.⁶ When both have changed, a smaller corner change combined with a brow lift often looks more natural than a large change at the corner alone.

If you have had threads in the area before, bring the dates and thread type; our guide to surgery after fillers or threads explains why this matters.

Frequently asked questions