Eyelid Retraction

What is eyelid retraction? Eyelid retraction is the abnormal elevation of the upper eyelids and abnormal lowering of the lower eyelids. Normally, upper eyelids rest just below the upper border of the cornea/iris, while normal bottom eyelid rests at the lower border of the cornea/iris.

Treatment Options for Eyelid Retraction

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 shaped 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!

Contact Dr. Taban for Expert Eyelid Retraction Treatment

Dr. Mehryar (Ray) Taban is a board-certified oculoplastic surgeon in Beverly Hills who has extensive experience and skill regarding the treatment of eyelid retraction. To learn more about the different treatment options for abnormal eyelid elevation, contact Dr. Taban today to schedule a consultation.

*See disclaimer below

18-year-old male, with congenital lower eyelid retraction with negative canthal tilt and droopy upper eyelids (ptosis), underwent almond eye surgery including lower eyelid retraction surgery (with internal alloderm spacer graft), canthoplasty, and upper eyelid ptosis surgery. Before and 3 months after cosmetic eye transforming surgery photos are shown.18-year-old male, with congenital lower eyelid retraction with negative canthal tilt and droopy upper eyelids (ptosis), underwent almond eye surgery including lower eyelid retraction surgery (with internal alloderm spacer graft), canthoplasty, and upper eyelid ptosis surgery. Before and 3 months after cosmetic eye transforming surgery photos are shown.

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 shaped 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!

 

Watch Dr. Taban on the DOCTORS TV show discussing Almond Eye Surgery.

Video showing young man who underwent lower eyelid retraction surgery with canthoplasty and droopy upper eyelid ptosis surgery to make eyes more almond shaped.
Los Angeles Droopy Lid Surgery

Read Dr. Taban's manuscript about Lower Eyelid Retraction Surgery Without Spacer Grafts.

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Los Angeles Droopy Eyes Correction

Read Dr. Taban's manuscript about Lower Eyelid Retraction Surgery with Alloderm.

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Dr. Mehryar Taban Manuscript Bulging Eyes and Eyelid Retraction

Read Dr. Taban's Manuscript about Combined Orbital Decompression and Eyelid Retraction Surgery.

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Read more about Dr. Taban's manuscript about Lower Eyelid Retraction Surgery.

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Read Dr. Taban's manuscript about En-Glove Approach to Eyelid Retraction Surgery with Alloderm and Dermis-Fat Grafts.

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Read Dr. Taban's manuscript about Aesthetic Lateral Canthoplasty.

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Audio video of a woman who discusses her journey after suffering from lower eyelid retraction after transcutaneous lower blepharoplasty (by another surgeon) and finally being treated by Dr Taban who performed lower eyelid retraction repair.

Video showing almond eye surgery with canthoplasty in a young woman with congenital lower eyelid retract

Video showing a man who flew from Miami to California to undergo cosmetic orbital decompression, lower eyelid retraction surgery and lower orbital rim silicone implant to correct congenital bulging eyes and lower eyelid retraction.

Video showing young mom with Graves thyroid eye disease who underwent orbital decompression, lower eyelid retraction surgery, and orbital rim implant to correct bulging eyes and lower eyelid retraction.

Video showing post-blepharoplasty revision lower eyelid retraction surgery in a woman who came from Russia.

Addition 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).

*See disclaimer below

18 year old male, with congenital lower eyelid retraction with negative canthal tilt and droopy upper eyelids (ptosis) underwent almond eye surgery including lower eyelid retraction surgery (with internal alloderm spacer graft), canthoplasty, and upper eyelid ptosis surgery. Before and 3 months after cosmetic eye transforming surgery photos are shown.
18 year old male, with congenital lower eyelid retraction with negative canthal tilt and droopy upper eyelids (ptosis) underwent almond eye surgery including lower eyelid retraction surgery (with internal alloderm spacer graft), canthoplasty, and upper eyelid ptosis surgery. Before and 3 months after cosmetic eye transforming surgery photos are shown.


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.

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.
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.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) 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 (left) and after (right photo) of right ptosis surgery, left upper eye surgery and bilateral lower blepharoplasty.

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 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) 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.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 RealSelf38 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) 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 using 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 using skin graft.

32 year old female, with congenital lower eyelid retraction and canthal dystopia with mongloid slant, underwent Almond Eye Surgery (lower eyelid retraction surgery, soof lift, spacer graft, canthoplasty). Before and 3 months after almond eye surgery photos are shown.32 year old female, with congenital lower eyelid retraction and canthal dystopia with mongloid slant, underwent Almond Eye Surgery (lower eyelid retraction surgery, soof lift, spacer graft, canthoplasty). Before and 3 months after almond eye surgery photos are shown.

47 year old Russian female, with post-blepharoplasty lower eyelid retraction and sclera show and rounded eyes, underwent revision eyelid surgery with lower eyelid retraction surgery (internal eyelid lift, alloderm spacer graft, canthoplasty) to restore almond eye shape. Before and 3 months after lower eyelid retraction repair photos are shown.47 year old Russian female, with post-blepharoplasty lower eyelid retraction and sclera show and rounded eyes, underwent revision eyelid surgery with lower eyelid retraction surgery (internal eyelid lift, alloderm spacer graft, canthoplasty) to restore almond eye shape. Before and 3 months after lower eyelid retraction repair photos are shown.

Before (left) and after (right) 44-year-old female, with post-blepharoplasty lower eyelid retraction with sclera show and loss of natural eye shape, underwent corrective revision lower eyelid surgery, namely lower eyelid retraction repair, using internal eyelid approach with soof lift and alloderm spacer graft and canthoplasty.Before (left) and after (right) 44-year-old female, with post-blepharoplasty lower eyelid retraction with sclera show and loss of natural eye shape, underwent corrective revision lower eyelid surgery, namely lower eyelid retraction repair, using internal eyelid approach with soof lift and alloderm spacer graft and canthoplasty.

46 year old Asian female, with lower eyelid retraction after previous transcutaneous lower blepharoplasty, underwent revision eyelid surgery to raise the lower eyelids (lower eyelid retraction surgery) using internal eyelid approach with soof lift and internal alloderm graft and canthoplasty. Before and 5 months after oculoplastic surgery photos are shown.46 year old Asian female, with lower eyelid retraction after previous transcutaneous lower blepharoplasty, underwent revision eyelid surgery to raise the lower eyelids (lower eyelid retraction surgery) using internal eyelid approach with soof lift and internal alloderm graft and canthoplasty. Before and 5 months after oculoplastic surgery photos are shown.

Young Asian female, with inherited bulging eyes, lower eyelid retraction with sclera show, underwent scarless orbital decompression and lower eyelid retraction surgery. She can now close her eyes normally with improved natural eye shape.Young Asian female, with inherited bulging eyes, lower eyelid retraction with sclera show, underwent scarless orbital decompression and lower eyelid retraction surgery. She can now close her eyes normally with improved natural eye shape.

Young Asian female, with inherited bulging eyes, lower eyelid retraction with sclera show, underwent scarless orbital decompression and lower eyelid retraction surgery. She can now close her eyes normally with improved natural eye shape.
Young Asian female, with inherited bulging eyes, lower eyelid retraction with sclera show, underwent scarless orbital decompression and lower eyelid retraction surgery. She can now close her eyes normally with improved natural eye shape.

31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos arn.e show
31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos arn.e show

31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos are shown.
31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos are shown.

31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos are shown.
31 year old African American female, with inherited bulging eyes due to shallow orbits and lower eyelid retraction with sclera show. She underwent cosmetic orbital decompression and lower eyelid retraction surgery. Before and 3 months after transforming eye plastic surgery photos are shown.

38 year old Asian female, with severe bulging eyes due to Graves thyroid eye disease, along with lower eyelid retraction with scleral show. She underwent combined orbital decompression surgery and lower eyelid retraction surgery. Before and 6 weeks after transforming eye plastic surgery photos are shown.38 year old Asian female, with severe bulging eyes due to Graves thyroid eye disease, along with lower eyelid retraction with scleral show. She underwent combined orbital decompression surgery and lower eyelid retraction surgery. Before and 6 weeks after transforming eye plastic surgery photos are shown.

38 year old Asian female, with severe bulging eyes due to Graves thyroid eye disease, along with lower eyelid retraction with scleral show. She underwent combined orbital decompression surgery and lower eyelid retraction surgery. Before and 6 weeks after transforming eye plastic surgery photos are shown.
38 year old Asian female, with severe bulging eyes due to Graves thyroid eye disease, along with lower eyelid retraction with scleral show. She underwent combined orbital decompression surgery and lower eyelid retraction surgery. Before and 6 weeks after transforming eye plastic surgery photos are shown.

49 year old male, with history of multiple prior lower eyelid operations with resultant right lower eyelid retraction, underwent revision lower eyelid retraction surgery (internal approach, soof lift, alloderm spacer graft, canthoplasty). Before and 3 months after revisional eyelid surgery photos are shown.
49 year old male, with history of multiple prior lower eyelid operations with resultant right lower eyelid retraction, underwent revision lower eyelid retraction surgery (internal approach, soof lift, alloderm spacer graft, canthoplasty). Before and 3 months after revisional eyelid surgery photos are shown.

50 year old female, with history of left eye trauma resulting in orbital fracture with sunken eye and severe left lower eyelid retraction with scarring, underwent left orbital fracture repair with orbital implant, left lower eyelid retraction surgery with skin graft, bilateral blepharoplasty, and eyelid filler injection. Before and 3 months after eyelid surgery photos are shown.
50 year old female, with history of left eye trauma resulting in orbital fracture with sunken eye and severe left lower eyelid retraction with scarring, underwent left orbital fracture repair with orbital implant, left lower eyelid retraction surgery with skin graft, bilateral blepharoplasty, and eyelid filler injection. Before and 3 months after eyelid surgery photos are shown.

50 year old female, with history of left eye trauma resulting in orbital fracture with sunken eye and severe left lower eyelid retraction with scarring, underwent left orbital fracture repair with orbital implant, left lower eyelid retraction surgery with skin graft, bilateral blepharoplasty, and eyelid filler injection. Before and 3 months after eyelid surgery photos are shown.
50 year old female, with history of left eye trauma resulting in orbital fracture with sunken eye and severe left lower eyelid retraction with scarring, underwent left orbital fracture repair with orbital implant, left lower eyelid retraction surgery with skin graft, bilateral blepharoplasty, and eyelid filler injection. Before and 3 months after eyelid surgery photos are shown.

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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) 278-1836

Next, read about eye asymmetry

*Disclaimer: Results vary from patient to patient. Results are not guaranteed.

Lower Eyelid Retraction

Dr. Taban came highly rated by my initial facial surgeon at UCLA in Los Angeles. … I am very pleased. Dr. Taban performed a lower lid lift. … I recommend him highly.

Jan in Santa Barbara

Santa Barbara November 2, 2016

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