Patient had transcutaneous lower blepharoplasty complicated by eyelid retraction. Three failed attempts at repair by various surgeons over several years had worsened her condition to a severe state.
1. The lateral canthal tendon was released from the lateral bony rim and the lower eyelid was reflected downward. A transconjunctival incision was made on the back surface of the eyelid into its middle layers, and extensive scar tissue was removed. Tissue shortage in the middle and back eyelid layers was corrected by placement of a spacer graft (shown just prior to being sutured into the eyelid).
2. To add vertical support, the SOOF (sub orbicularis oculi fat) was lifted (top suture shown attached to the SOOF) and the lateral canthus was resuspended by lateral canthoplasty (bottom suture shown attached to the tarsal plate).
3. Sutures have been pulled towards their final positions to demonstrate the vertical lift on the eyelid and upper cheek just prior to being attached to the lining (periosteum) of the orbital bone.
Three Months After
Note: The patient later underwent reinforcement of her canthoplasty to further enhance the result (not shown).