Eyelid Retraction Surgery
Normal upper eyelid rests just below the upper border of the cornea/iris, while normal bottom eyelid rests at the lower border of the cornea/iris. Eyelid retraction is the abnormal elevation of the upper eyelids and abnormal lowering of the lower eyelids.
Before (left) 17 year old female with inherited lower eyelid retraction, sclera show and under eye hollowness, with sad looking eyes. After (right) 2 months after lower eyelid retraction surgery, canthoplasty, tear trough implants. Note more attractive almond shape eyes.
Before (left) 17 year old female with inherited lower eyelid retraction, sclera show and under eye hollowness, with sad looking eyes. After (right) 2 months after lower eyelid retraction surgery, canthoplasty, tear trough implants. Note more attractive almond shape eyes.
What Causes Eyelid Retraction?
There are various causes of this eye condition, including congenital, thyroid eye disease (Graves’ disease), trauma, and prior surgery. Most common cause of retraction of the upper eyelids is thyroid disease followed by genetics. The most common cause of lower eyelid retraction is from complications from prior lower blepharoplasty (post-blepharoplasty retraction), where either scar tissue developed and/or if too much skin was excised from the bottom eye fold. This eye condition can appear as eye rounding and scleral show and very importantly it results in surgical (unnatural) eye and facial appearance. It can lead to chronic eye conditions including dry eyes, excessive tearing, redness, burning and blurred vision.
Another common cause of retraction of the lower eye fold is genetics, where the lower eyelids are too low with scleral show. These patients often complain about their eye shape while desiring more almond shape eyes. They want surgery to correct the scleral show. It is important to understand that sometimes large eyeballs or bulging eyes can force the bottom eyelids to be too low, which means sometimes the eyeballs have to be set back (through orbital decompression) to allow the lower eyelids to come up. A good analogy to consider is someone’s pants can fall down if the belly is too big!
Treatment
The first line of therapy is ocular protection using frequent ocular lubrication (drops and ointment), bandage contact lens, etc. Oculoplastic surgery is inevitably needed since the eyes will get drier as time progresses. This eye condition surgery is done differently. For upper eyelid surgery, the levator muscle (responsible for lifting the upper eye fold) is cut to lower the upper eyelid. Oculoplastic surgery for retraction of the bottom eyelids works differently.
There are various surgical techniques, usually performed via a posterior (hidden) approach. At times, grafts and/or midface (cheek) lift may be needed to help elevate the bottom eyelid and reduce the scleral show.
Tightening of the lower eyelids is usually concurrently performed through canthoplasty where the outer eye corner is tightened.
Lower eyelid retraction surgery can help achieve more almond shape eyes.
At times, orbital decompression may be necessary as an initial step (prior to this oculoplastic surgery) if big eyeballs or bulging eyes are forcing the lower eye to fold too low. Going back to the previous analogy, if someone’s big belly is reduced, their pants can come up higher!
Read Dr. Taban's manuscript about Lower Eyelid Retraction Surgery Without Spacer Grafts.
Click to ReadRead Dr. Taban's manuscript about Lower Eyelid Retraction Surgery with Alloderm.
Click to ReadRead more about Dr. Taban's manuscript about Lower Eyelid Retraction Surgery.
Click to ReadRead Dr. Taban's manuscript about En-Glove Approach to Eyelid Retraction Surgery with Alloderm and Dermis-Fat Grafts.
Click to ReadRead Dr. Taban's manuscript about Aesthetic Lateral Canthoplasty.
Click to ReadAddition information on oculoplastic surgery can be found on AAO.org.
Before & After Photos
Dr. Taban is an expert LA oculoplastic surgeon, using minimally invasive techniques, helping patients locally and around the world with this difficult problem, in his 2 offices in the greater Los Angeles area (Beverly Hills and Santa Barbara).
Before (left), 24 year old female, with severe bulgy eyes and lower eyelid retraction from Grave’s Disease, with significant change in eye appearance and function. After (right), 1 month after bilateral orbital decompression surgery and lower eyelid retraction surgery. Note improved eye appearance.
Before (left), 24 year old female, with severe bulgy eyes and lower eyelid retraction from Grave’s Disease, with significant change in eye appearance and function. After (right), 1 month after bilateral orbital decompression surgery and lower eyelid retraction surgery. Note improved eye appearance.
Young male with congenital rounded eyes and bottom eyelid retraction with scleral show who underwent this eye condition surgery with internal Alloderm graft and canthoplasty, resulting in elevation of the lower eye fold in a more natural position. He also had tear trough silicone implants placed.
Middle age male, with thyroid eye disease, who underwent orbital decompression followed later by bottom eyelid retraction surgery and canthoplasty.
Before (left) and after (right) bilateral lower eyelid retraction surgery with internal dermis-fat graft.
Before (left) and after (right photo) of right ptosis surgery, left upper eye surgery and bilateral lower blepharoplasty.
Before and 3 months after LEFT retraction of the eyelid surgery without graft, under LOCAL anesthesia.
Before (left) Middle age woman with multiple prior eye fold surgeries and blepharoplasty, resulting in right lateral canthal angle distortion and lowering, unnatural right lower eyelid contour, and droopy upper eyelid. After (right) 2 months after revisional eye fold surgery, right canthoplasty, right lower eyelid retraction surgery (internal, with midface lift, without graft) and lower eye fold contour surgery.
Before (left) Middle age woman with right lower eyelid retraction after previous lower blepharoplasty, now needing revision cosmetic surgery. After (right) 4 months after this eye condition surgery with internal alloderm graft, midface lift, canthoplasty, giving more natural almond shape eye appearance. (later she would also benefit from ptosis surgery and brow lift).
Before (left) Young male, with eye size asymmetry, secondary to right upper eyelid retraction. After (right) 3 months after right upper eyelid retraction correction. Note improved eye symmetry.
38 year old male, with lower eyelid retraction due to previous lower blepharoplasty (by another surgeon), underwent lower eyelid retraction surgery (with alloderm spacer graft), canthoplasty, and tear trough (orbital rim) implant placement. Before and 6 months after surgery results are shown. You can see his written testimonial on RealSelf https://www.realself.com/review/beverly-hills-ca-eyelid-retraction-repair-eyelid-retraction-surgery
Before (left) middle aged man with severe left lower eyelid retraction after previous lower eyelid surgery. After (right) 3 months post revision lower eyelid retraction surgery with internal alloderm spacer graft and external skin graft.
Before (left) revision lower eyelid surgery to raise droopy lower eyelids following two previous procedures from other surgeons. After (right) one month post eyelid reconstruction.
Contact the Los Angeles Oculoplastic Expert
Dr. Taban is one of the leading oculoplastic eye surgery doctors in the LA region. Contact us via online support form, or via telephone at: (310) 499-2565
Next, read about eye asymmetry
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