Treatment of Lower Eyelid Retraction

Cho, In Chang

Abstract

With the average life expectancy increasing and a larger percent of the population aging, more patients of an older demographics are undergoing periocular facial rejuvenation procedures. One of the most common procedures performed for periocular rejuvenation is the lower lid blepharoplasty. As interest in this type of surgery increases however, we are seeing more complications associated with this procedure. One of the most common and challenging postoperative complication after this procedure is lower lid retraction. The degree of lower lid retraction can present in a varying range from lateral canthal rounding and scleral show to cicatricial ectropion. Causes of lower eyelid retraction seem to be multifactorial and there are a variety of surgical approaches for correction of lower eyelid retraction. According to the cause and degree of lower lid retraction, the author must incorporate a customized approach for each deformity. In this study, 33 patients had corrective surgery to treat lower eyelid retraction between July 2004 and June 2006. Of these, only one patient presented for primary correction all others were secondary cases. Techniques used to correct lower lid retraction included a midface lift, a lateral canthopexy or canthoplasty, an oculi muscle suspension, or a spacer graft. There was noted improvement in all cases performed, however a mild degree of recurrence was noted in 6 cases. To effectively correct lower lid retraction, the surgeon must have a sound understanding of the anatomy of the lower eyelid. Technically, key essential fundamentals to correcting lower lid retraction include: knowledge of elevating the mid face, anchoring the lateral canthal tendon securely, and proper insertion of the spacer graft. This article presents multiple techniques to correct significant postsurgical lower lid malposition without the use of skin grafts.