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Topic 30 - 2
Lower Eyelid Collapse:
Not The Same as Retraction
treatment lower blepharoplasty complications Risks & Revision lower eyelid retraction repair

Lower eyelid collapse is an acquired condition in which there is enough loss of orbital fat in the socket space beneath the eyeball to allow the eyelid to fall or "collapse" downward into the void. It may be mild, moderate, or severe. In the most severe cases, the eyeball may also descend and have difficulty moving normally.

eyelid collapse
Lower eyelid collapse after
transconjunctival blepharoplasty

The most common cause of eyelid collapse is overdone fat removal during lower blepharoplasty from either a transcutaneous or transconjunctival approach, especially if accompanied by aggressive fat repositioning. The condition is also seen much less frequently following orbital fat manipulation during repair of complex retinal disorders.

Eyelid Retraction

Eyelid collapse may be misdiagnosed as "eyelid retraction," a very different complication which has received much more attention. With true retraction, however, the lid is actively pulled down due to internal scarring creatiang a strong physical force against which it cannot rise.

tight spring
Strong resistance to movement

Eyelid Collapse

With eyelid collapse, there is no anatomic physical restriction or pulling but rather a passive loss of foundational structural support from below, most commonly following excessive removal or repositioning of orbital fat during blepharoplasty.

poor foundation
Foundation weakened
(excessive fat removal)

leading to -->

Structural collapse
(eyelid collapse)

Some patients may demonstrate simultaneous retaction, thus complicating recognition and treatment.


Repair of eyelid collapse is especially difficult and options are limited. The missing volume located in the space beneath the eye must be replaced. Fat injections commonly used to fill in superficial grooves on the face are seldom able to provide the amount of needed volume to the correct area. Commercial injectable fillers have also been tried without true reconstructive success but some temporary "cosmetic" success.

strong foundation
Foundation restored
(deep fat grafting)

To our knowledge, the only effective procedure capable of providing adequate orbital volume replacement for moderate or severe eyelid collapse is "pearl fat grafting," also known as "orbital fat grafting," a procedure that is not widely available.

after orbital fat grafting
Six months after orbital fat grafting

Treatment of eyelid and orbital volume deficiency is a complex surgical subject reviewed in its own section (Hollowness).

Next: Sample Revision:
Lower Eyelid Retraction

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