Abstract
Lid retraction is a feared complication of lower blepharoplasty. Anatomical variations
like negative orbital vector, horizontal lid laxity, and preexisting lid retraction
are more prone to lid malpositions. Meticulous and precise execution of a series of
surgical steps is key to preventing complications. This includes minimizing surgical
trauma, meticulous hemostasis, preserving innervation to the medial lid and pretarsal
orbicularis, safe method of fat excision, septal tightening while maintaining lid
traction, and conservative and titrated skin excision. Canthal fixation addresses
lid laxity and maintains the lid stretched vertically while postoperative healing
and fibrosis are taking place. Post-blepharoplasty lid retraction may occur due to
failure to address lid laxity and the occurrence of middle lamellar fibrosis. Excessive
skin excision may also result in anterior lamellar deficiency. The “sag and drag”
concept is useful to evaluate the post-blepharoplasty retracted lid. The treatment
of the retracted lid includes lid massage, replacing the anterior lamella, or releasing
the middle lamellar fibrosis or a combination of techniques. In conclusion, understanding
the mechanisms of lid retraction, careful preoperative assessment, and surgical precision
will help surgeons to prevent and manage this complication.
Keywords
lower lid blepharoplasty - lower lid retraction - post-blepharoplasty ectropion
