Management of the Post-lower Eyelid Blepharoplasty Retracted Eyelid

  • Dan Georgescu
  • Geeta Belsare
  • John D. McCann
  • Richard L. Anderson
Chapter

Abstract

Lower eyelid retraction is a feared complication of blepharoplasty surgery with both functional and cosmetic consequences such as exposure keratopathy, irritated eyes, blurry vision, lateral canthal dystopia, round eye, and sclera show. Lower eyelid retraction occurs when the blepharoplasty surgery removes too much tissue from the lower eyelid, the lower eyelid tissue contracts with scarring, or the orbicularis oculi muscle tone becomes weakened by the procedure. In many cases, the patient does not develop exposure symptoms until years after the procedure, when gravity causes the midface to sag and the tear film becomes inadequate. Depending on the pathophysiological mechanism involved, surgical correction may involve horizontal tightening of the lower eyelid, pre- or subperiosteal midface lift, and/or posterior lamellar grafting. For the most severe cases, full thickness skin grafting becomes necessary. The goal of eyelid reconstruction in patients presenting with eyelid retraction after blepharoplasty surgery is to restore the position, the function, and the appearance of the lower eyelid to a level that is at least as good, if not better, than the preblepharoplasty level.

Keywords

Entropion Fatigued Shrinkage Expense Candidiasis 

References

  1. 1.
    Neuhaus R, Baylis H. Complications of lower eyelid blepharoplasty. In: Putterman AM, editor. Cosmetic oculoplastic surgery. New York, NY: Grune & Stratton; 1982.Google Scholar
  2. 2.
    McGraw BL, Adamson PA. Postblepharoplasty ectropion. Arch Otolaryngol Head Neck Surg. 1991;117:852.PubMedGoogle Scholar
  3. 3.
    Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg. 2000;106:438.PubMedCrossRefGoogle Scholar
  4. 4.
    Kersten RC, Kulwin DR, Levartovsky S, et al. Management of lower-lid retraction with hard-palate mucosa grafting. Arch Ophthalmol. 1990;108:1339.PubMedGoogle Scholar
  5. 5.
    Shorr N, Fallor MK. “Madame Butterfly” procedure: combined cheek and lateral canthal suspension procedure for post-blepharoplasty, round eye, and lower eyelid retraction. Ophthal Plast Reconstr Surg. 1985;1:229.PubMedGoogle Scholar
  6. 6.
    Jordan DR, Anderson RL. The tarsal tuck procedure: avoiding eyelid retraction after lower blepharoplasty. Plast Reconstr Surg. 1990;85:22.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolff E. Anatomy of the Eye and Orbit. 7th ed. Philadelphia, PA: Saunders; 1976.Google Scholar
  8. 8.
    Cohen MS, Shorr N. Eyelid reconstruction with hard palate mucosa graft. Ophthal Plast Reconstr Surg. 1992;8:183–95.PubMedCrossRefGoogle Scholar
  9. 9.
    McCord Jr CD, Ellis DS. The correction of lower lid malposition following lower lid blepharoplasty. Plast Reconstr Surg. 1993;92:1068.PubMedCrossRefGoogle Scholar
  10. 10.
    Shorr N. Madame Butterfly procedure with hard palate graft: management of post-blepharoplasty round eye and scleral show. Facial Plast Surg. 1994;10:90.PubMedCrossRefGoogle Scholar
  11. 11.
    Patel BC, Patipa M, Anderson RL, McLeish W. Management of post-blepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip. Plast Reconstr Surg. 1997;99:1251.PubMedCrossRefGoogle Scholar
  12. 12.
    McCord Jr CD, Shore JW. Avoidance of complications in lower lid blepharoplasty. Ophthalmology. 1983;90:1039.PubMedGoogle Scholar
  13. 13.
    Edgerton Jr MT. Causes and prevention of lower eyelid ectropion following blepharoplasty. Plast Reconstr Surg. 1972;49:367.PubMedCrossRefGoogle Scholar
  14. 14.
    Tenzel RR. Complications of blepharoplasty, orbital hematoma, ectropion and scleral show. Clin Plast Surg. 1981;8:797.PubMedGoogle Scholar
  15. 15.
    Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol. 1979;97(11):2192–6.PubMedGoogle Scholar
  16. 16.
    Anderson RL. Tarsal strip procedure for correction of eyelid laxity and canthal malposition in the anophthalmic socket. Ophthalmology. 1981;88(9):895–903.PubMedGoogle Scholar
  17. 17.
    Jordan DR, Anderson RL. The lateral tarsal strip revisited. Arch Ophthalmol. 1989;107(4):604–6.PubMedGoogle Scholar
  18. 18.
    Karesh JW, Nirankari VS, Hameroff SB. Eyelid imbrication. An unrecognized cause of chronic ocular irritation. Ophthalmology. 1993;100(6):883–9.PubMedGoogle Scholar
  19. 19.
    Donnenfeld ED, Perry HD, Schrier A, Zagelbaum B, Rodgers R. Lid imbrication syndrome. Diagnosis with rose bengal staining. Ophthalmology. 1994;101(4):763–6.PubMedGoogle Scholar
  20. 20.
    Vagefi MR, Anderson RL. The lateral tarsal strip mini-tarsorrhaphy procedure. Arch Facial Plast Surg. 2009;11(2):136–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Webster RC, Davidson TM, Reardon EJ, Smith RC. Suspending sutures in blepharoplasty. Arch Otolaryngol. 1979;105(10):601–4.PubMedGoogle Scholar
  22. 22.
    Whitaker LA. Selective alteration of palpebral fissure form by lateral canthopexy. Plast Reconstr Surg. 1984;74(5):611–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Hamra ST. The role of the septal reset in creating a youthful eyelid-cheek complex in facial rejuvenation. Plast Reconstr Surg. 2004;113(7):2124–41; discussion 2142–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Hamra ST. The zygorbicular dissection in composite rhytidectomy: an ideal midface plane. Plast Reconstr Surg. 1998;102(5):1646–57.PubMedCrossRefGoogle Scholar
  25. 25.
    Rizvi M, Lypka M, Gaon M, Kovacev T, Eisemann B, Eisemann MJ. Minimally invasive lateral canthopexy (MILC). J Plast Reconstr Aesthet Surg. 2010;63(9):1434–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Shorr N, Perry JD, Goldberg RA, et al. The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery. Ophthal Plast Reconstr Surg. 2000;16:223.PubMedCrossRefGoogle Scholar
  27. 27.
    Rubin PA, Fay AM, Remulla HD, Maus M. Ophthalmic plastic applications of acellular dermal allografts. Ophthalmology. 1999;106:2091.PubMedCrossRefGoogle Scholar
  28. 28.
    Fay AM, Pieroth L, Rubin PAD. An animal model of lower eyelid spacer grafting with acellular dermis. Ophthal Plast Reconstr Surg. 2001;17:270.PubMedCrossRefGoogle Scholar
  29. 29.
    Patipa M, Patel BC, McLeish W, Anderson RL. Use of palate grafts for treatment of post-surgical lower eyelid retraction: a technical review. J Craniomaxillofac Trauma. 1996;2:18.PubMedGoogle Scholar
  30. 30.
    van der Meulen JC. The use of mucosa-lined flaps in eyelid reconstruction: a new approach. Plast Reconstr Surg. 1982;70:139.PubMedCrossRefGoogle Scholar
  31. 31.
    Marks MW, Argenta LC, Friedman RJJ, Hall JD. Conchal cartilage and composite grafts for correction of lower lid retraction. Plast Reconstr Surg. 1989;83:629.PubMedCrossRefGoogle Scholar
  32. 32.
    Holt JE, Holt GR, Van Kirk M. Use of temporalis fascia in eyelid reconstruction. Ophthalmology. 1984;91:89.PubMedGoogle Scholar
  33. 33.
    Obear MF, Smith B. Tarsal grafting to elevate the lower lid margin. Am J Ophthalmol. 1965;59:1088.PubMedGoogle Scholar
  34. 34.
    Baylis HI, Rosen N, Neuhaus RW. Obtaining auricular cartilage for reconstructive surgery. Am J Ophthalmol. 1982;93:709.PubMedGoogle Scholar
  35. 35.
    Siegel RJ. Palatal grafts for eyelid reconstruction. Plast Reconstr Surg. 1985;76:411.PubMedCrossRefGoogle Scholar
  36. 36.
    Vecchione TR. Palatal grafts for lip reconstruction. Ann Plast Surg. 1983;10:301.PubMedCrossRefGoogle Scholar
  37. 37.
    Yoshimura Y, Nakajima T. Tracheoplasty with palatal mucoperiosteal graft. Plast Reconstr Surg. 1990;86:558.PubMedCrossRefGoogle Scholar
  38. 38.
    Hall HD, O’Steen AN. Free grafts of palatal mucosa in mandibular vestibuloplasty. J Oral Surg. 1970;28:565.PubMedGoogle Scholar
  39. 39.
    Holck DE, Foster JA, Dutton JJ, Dillon HD. Hard palate mucosal grafts in the treatment of the contracted socket. Ophthal Plast Reconstr Surg. 1999;15:202.PubMedCrossRefGoogle Scholar
  40. 40.
    Doxanas MT, Dryden RM. The use of sclera in the treatment of dysthyroid eyelid retraction. Ophthalmology. 1981;88:887.PubMedGoogle Scholar
  41. 41.
    Karesh JW, Fabrega MA, Rodrigues MM, Glaros DS. Poly tetrafluoroethylene as an interpositional graft material for the correction of lower eyelid retraction. Ophthalmology. 1989;96:419.PubMedGoogle Scholar
  42. 42.
    Sullivan SA, Dailey RA. Graft contraction: a comparison of acellular dermis versus hard palate mucosa in lower eyelid surgery. Ophthal Plast Reconstr Surg. 2003;19:14.PubMedCrossRefGoogle Scholar
  43. 43.
    Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns. 1995;21:243.PubMedCrossRefGoogle Scholar
  44. 44.
    Tobin HA, Karas ND. Lip augmentation using an AlloDerm graft. J Oral Maxillofac Surg. 1998;56:722.PubMedCrossRefGoogle Scholar
  45. 45.
    Kridel RW, Foda H, Lunke KC. Septal perforation repair with ­acellular human dermal allograft. Arch Otolaryngol Head Neck Surg. 1998;124:73.PubMedGoogle Scholar
  46. 46.
    Jones FR, Schwartz BM, Silverstein P. Use of a nonimmunogenic acellular dermal allograft for soft tissue augmentation. Aesthet Surg Q. 1996;16:196–201.CrossRefGoogle Scholar
  47. 47.
    Patrinely JR. Application of acellular dermal allografts. Ophthalmology. 2000;107:1966.PubMedCrossRefGoogle Scholar
  48. 48.
    Zarem HA, Resnick JI. Expanded applications for transconjunctival lower lid blepharoplasty. Plast Reconstr Surg. 1991;88:215.PubMedCrossRefGoogle Scholar
  49. 49.
    Kim JW, Ellis DS, Stewart WB. Correction of lower eyelid retraction by transconjunctival retractor excision and lateral eyelid suspension. Ophthal Plast Reconstr Surg. 1999;15:341.PubMedCrossRefGoogle Scholar
  50. 50.
    Goldberg RA, Lessner AM, Shorr N, Baylis HI. The transconjunctival approach to the orbital floor and orbital fat: a retrospective study. Ophthal Plast Reconstr Surg. 1990;6:241.PubMedCrossRefGoogle Scholar
  51. 51.
    Baylis HI, Nelson ER, Goldberg RA. Lower eyelid retraction following blepharoplasty. Ophthal Plast Reconstr Surg. 1992; 8:170.PubMedCrossRefGoogle Scholar
  52. 52.
    Taban M, Douglas R, Li T, Goldberg RA, Shorr N. Efficacy of “thick” acellular human dermis (AlloDerm) for lower eyelid reconstruction: comparison with hard palate and thin AlloDerm grafts. Arch Facial Plast Surg. 2005;7(1):38–44.PubMedCrossRefGoogle Scholar
  53. 53.
    Spinelli HM. Atlas of aesthetic eyelid and periocular surgery. Philadelphia: Saunders; 2004. p. 23–57, 120–35, 163.Google Scholar
  54. 54.
    Anderson RDA, Lo MW. Endoscopic malar/midface suspension procedure. Plast Reconstr Surg. 1998;102:2196.PubMedCrossRefGoogle Scholar
  55. 55.
    Hinderer UT. Vertical preperiosteal rejuvenation of the frame of the eyelids and midface. Plast Reconstr Surg. 1999;104:1482.PubMedCrossRefGoogle Scholar
  56. 56.
    Hester TR, Codner MA, McCord CD. The “centrofacial” approach for correction of facial ageing using the transblepharoplasty subperiosteal cheek lift. Aesthet Surg Q. 1996;16:51.CrossRefGoogle Scholar
  57. 57.
    Edelstein C, Balch K, Shorr N, Goldberg RA. The transeyelid subperiosteal midface-lift in the unhappy postblepharoplasty patient. Semin Ophthalmol. 1998;13(3):107–14. Review.PubMedCrossRefGoogle Scholar
  58. 58.
    Patel MP, Shapiro MD, Spinelli HM. Combined hard palate spacer graft, midface suspension, and lateral canthoplasty for lower eyelid retraction: a tripartite approach. Plast Reconstr Surg. 2005;115(7): 2105–14; discussion 2115–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Dan Georgescu
    • 1
  • Geeta Belsare
    • 2
  • John D. McCann
    • 3
  • Richard L. Anderson
    • 3
  1. 1.Wilmer Eye InstituteJohns Hopkins Medical CenterBaltimoreUSA
  2. 2.Department of OphthalmologyLoyola University Medical Center, Stritch School of MedicineMaywoodUSA
  3. 3.Center for Facial AppearancesSalt Lake CityUSA

Personalised recommendations