Overview
Lower eyelid retraction is a common complication after cosmetic surgery of the lower eyelids, midface and adjacent face. The author describes how it presents, what causes it based on surgical observations, a system for evaluating patients, and the procedures used to correct it. The abstract does not state how many patients were treated.
Findings
- Definition: the lower eyelid margin sits too low, without the lid turning outward.
- Signs: scleral show; round, sad-looking eyes; lateral canthal tendon laxity.
- Symptoms: ocular irritation, including photophobia, excessive tearing and nocturnal lagophthalmos.
- Artificial tears and ointments often provide only minimal relief.
- The author observed that the retraction is usually accompanied by midface descent.
- Causes appear multifactorial: scarring between the orbital septum and the capsulopalpebral fascia, lateral canthal tendon laxity, and midface descent.
- Correction requires tightening a lax lateral canthal tendon, knowing lower eyelid anatomy from the conjunctiva to the skin, and elevating the midface.
- The author reports correction with minimal complications. No counts or rates are given.
What it means for a patient
- A lower eyelid that pulls down after eyelid, midface or face surgery is a known complication. It can show white below the iris and cause dry, irritated, watery eyes.
- Eye drops and ointments often help only a little. Repair targets the causes: scar, a loose outer eyelid corner and a fallen midface.
- Repair may combine several steps, so the evaluation before surgery matters.
- Limits: this is one surgeon's observations and methods. The abstract gives no patient numbers or success rates.
Why this paper matters
It links lower eyelid retraction after cosmetic surgery to midface descent, in addition to scarring and tendon laxity, and sets out an evaluation system that guides the choice of repair. Cited 128 times (NIH iCite, 2026-09-25).
Terms
- Lower eyelid retraction: the lower lid edge sitting lower than normal.
- Scleral show: visible white of the eye between the iris and the lower lid.
- Lateral canthal tendon: the band that anchors the outer corner of the eyelids to bone.
- Lagophthalmos: the eye not closing fully; nocturnal means during sleep.
- Photophobia: sensitivity to light.
- Orbital septum: a thin sheet of tissue that holds the eye socket fat in place.
- Capsulopalpebral fascia: the lower eyelid retractors, tissue that pulls the lower lid down when looking down.
- Midface descent: sagging of the cheek tissue below the eye.