What is lower eyelid retraction after eyelid surgery?

The lower eyelid is pulled downward, either due to scarring of the middle or back of the eyelid (true retraction) or shortage of lower eyelid skin (ectropion).  Retraction changes the eyelid shape and can lead to dryness of the eye surface.

How is lower eyelid retraction treated?

Skin shortage

If there is insufficient amount of eyelid skin (caused by skin removal during lower blepharoplasty or contraction from chemical peels or laser treatment) this is termed ectropion.  Mild cases can be improved with lid tightening (canthoplasty or orbitomalar ligament suspension).  Moderate cases may require cheek lifting at the same time.  Significant cases require skin grafting (from around the ear or collarbone) to add height to the front surface of the eyelid.  The scars from skin grafts of the lower eyelid are hidden in natural eyelid creases but the graft may be noticeable due to color, texture, or thickness differences.

Middle or posterior eyelid retraction (true retraction)

If there is scarring of the orbital septum or conjunctiva after lower eyelid surgery that causes tethering or retraction of lid, early steps toward correction include upward massage of the eyelid.  Stitches to pull the eyelid upward (temporary suture tarsorrhaphy) can help to stretch the area of tethering.  Exuberant scar formation can be reduced with off-label injections including steroids or antimetabolites (5-FU).  Often in early stages of retraction, improvement occurs with non-surgical treatments.

When the degree of lower eyelid retraction is more severe, the scar causing lid tethering is surgically released and a spacer graft is placed to prevent recurrence of the retraction and to provide vertical height and support to the eyelid.  The eyelid is approached from the  back surface and the septum and conjunctiva are released, allowing the eyelid to assume a higher position against the eye.  Spacer grafts can be taken from your own body (ear cartilage, hard palate, or dermis-fat) or can be obtained as a commercial product (acellular dermis).  An eyelid tightening (lateral tarsal tongue) is performed at the same time and the eyelid is stitched closed with upward traction during the early healing period.

Risks of lower eyelid retraction repair

The lower eyelid can retract again after the procedure.  There is a risk of loss of mobility of the eyelid (stiff lower lid) and visibility of the graft through the eyelid skin.  Further surgery may be required.