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Lower Eyelid Retraction

Lower eyelid retraction, like lower lid ectropion, is caused by a compromised support system but also by the shrinkage of any of several tissue layers (skin, muscle, retractors). Lid retraction can occur naturually, with aging, with thryoid disease, or as a consequence of overdone transcutaneous lower blepharoplasty.

In the photo below, overdone horizontal and vertical shortening during blepharoplasty caused the lower lid to pull down below the cornea (eyelid retraction), exposing the white of the eye (scleral show).

There is no one all-inclusive approach to the correction of lower eyelid retraction, and not all cases can be corrected. Repair of lower eyelid retraction after blepharoplasty is an advanced operation that must be individualized using techniques such as:

support reinforcement (canthoplasty)
grafting of an internal spacer (Alloderm, hard palate, etc.)
skin grafting
SOOF or midface lift, and/or
augmentation of insufficient bony support below the eye

eyelid retraction
Severe post-blepharoplasty
eyelid retraction

After tarsal strip resuspension and skin graft

Before   After

Lid retraction associated with thyroid disease is different and is more related to the pull of overactive eyelid muscles. It can range from mild to severe. Descent of the lower lid after excessive removal of orbital fat is not a matter of retraction but rather collapse from hollowing of the eye and eyelid's underlying natural support.

Correction is different from that used for mechanical retraction shown above.

Next: Ectropion

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Frank Meronk, Jr., M.D.
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