In our last blog, we went over the causes of eyelid retraction after lower lid blepharoplasty, a procedure to remove bags and excess skin from under the eyes. However, we did not expand on the therapeutic alternatives to correct this unwanted complication. Thus, we have decided to dedicate this blog to the treatment of lower eyelid scarring and retraction, a feared and relatively common complication of blepharoplasty.
Repair of lower eyelid retraction is not easy.
The first thing to keep in mind when facing this complication is that there is no simple way to correct the problem. Eyelid scarring and retraction are usually due to the removal of too much skin when performing blepharoplasty. Therefore, the most straightforward approach to the correction of the problem is inserting a skin graft on the lower eyelids. The main concern with this option is that skin grafts on the lower eyelids don’t generally heal well. This is not what a patient who had cosmetic plastic surgery wants. It would not make sense to worsen the appearance of an individual who wanted to improve it in the first place. Therefore, the task of the eyelid reconstructive surgeon is to resolve the problem of retraction and scarring while also respecting the patient’s cosmetic expectations.
Midface lift with bone fixation for lower eyelid retraction
An excellent way to recruit skin from the cheek without having to use a skin graft is by doing a procedure called midface lift with bone fixation. The operation consists of liberating the attachments of the midface tissues from the cheekbone and elevating them in a superolateral vector. The tissues are then fixated to the bony rim on the lateral aspect of the eye. This procedure will raise the cheeks and allow the skin of the upper midface to work as a “graft.” This way, the surgeon avoids a skin graft, and the final result is natural and aesthetically pleasing.
Midface lift is a complex operation performed as an outpatient procedure under general anesthesia. In most cases, patients can expect recovery times of about one month. Bruising and swelling may be quite pronounced during the first two weeks. Nevertheless, this is an elegant operation with remarkable and long-lasting results.
Lower eyelid hard palate grafts
When the eyelid retraction is severe, and the scar tissue affects all three layers of the eyelid, a hard palate graft is necessary. During the midface lift, as mentioned above, the graft is harvested from the mucosa of the hard palate. After excising the scar tissue, the graft is then sutured to the inside of the eyelids. The primary function of the graft is to increase the vertical length of the eyelid as the surgeon tries to elevate it to its normal position.
Canthopexy and canthal suspension
When lower eyelid retraction is mild and associated with eyelid laxity, a canthopexy or canthal suspension may be enough to correct the retraction. These are pretty simple operations done under local anesthesia in a minor procedure room. A small incision is made in the corner of the eyes, and a suture is used to anchor the eyelid tissue to the lateral bony rim. It is a quick and elegant way to fix mild eyelid retraction. However, it cannot address moderate to severe scarring and retraction (see videos).