What is lower eyelid retraction surgery? Effects of vertically widening the eyes and risks of excessive lowering

Lower eyelid retraction surgery lowers the outer edge of the lower eyelid slightly to make the eyes vertically wider and soften the appearance of upturned eyes.[1]In a study of 63 people, the outer edge of the lower eyelid lowered in everyone, but some experienced partial reversion, and 7.9% were not sufficiently satisfied.[1]Additionally, if the lower eyelid is lowered too much, it can lead to dry eyes and excessive tearing; careful judgment about how much to lower is important.[2][3].

What changes with lower eyelid retraction surgery?

What changes is the line of the outer edge of the lower eyelid. As the outer edge lowers, the outer corner of the eye widens vertically, and the appearance of an upturned eye shape is softened.[1].

In this study's method, the tarsal plate (the firm tissue within the lower eyelid) and the membrane of the bone beneath the eye were connected with sutures.[1]The tension of the sutures is adjusted to match the line desired by the patient.[1].

This differs in aim from surgery to widen the horizontal span of the eye. Lower eyelid retraction surgery is an operation to change the vertical and horizontal dimensions of the eye, particularly the vertical width at the outer corner.[1].

Which eye shape is it suited for?

It is suited for people with narrow vertical eye width or those whose lower eyelid line slopes upward outward.[1]The study also showed these two characteristics were the main target.[1].

Conversely, it is not recommended for people whose eyes protrude forward or whose lower eyelid lacks elasticity.[1]It is difficult to determine which applies to you by looking in a mirror alone, so have it confirmed during a consultation.

Does the effect last forever?

Partial reversion can occur. Of the 63 people mentioned earlier, 5 (7.9%) experienced partial reversion of the lowered outer edge, resulting in insufficient satisfaction.[1].

In a separate surgery where 400 people had the outer canthus tendon tightened to reshape the lower eyelid, 4% experienced reversion.[4]With eyelid-shaping surgery, accounting for some degree of reversion helps minimize the gap between expectation and outcome.

However, research specifically on lower eyelid retraction surgery involves a small number of people, and long-term outcomes are not yet well understood.[1].

What is the risk most important to avoid?

Excessive lowering. A state of the lower eyelid being lowered too much is known as a complication occurring in 3–20% after eyelid surgery.[2].

Excessive lowering can cause sensations of grittiness, excessive tearing, and surface scratches on the eye.[2]Dry eyes may also persist long-term.[3].

Increased visibility of the white of the eye below and outward-turned eyelid margins (ectropion) are also complications to watch for in lower eyelid surgery.[5][6]Corrective surgery for an eyelid that has been lowered too much is difficult and tends to revert again.[2].

Therefore, prioritizing the function of the eye over maximal enlargement is important. Avoiding excessive skin removal is also cited as a key point in preventing these complications.[5].

What should a consultation confirm to determine if it is right for you?

Important points to confirm are the vertical eye width, the slope of the lower eyelid line, the elasticity of the lower eyelid, and how much the eye protrudes. This will clarify whether lower eyelid retraction surgery is appropriate or if other options should be considered.

Also ask about how much lowering is planned and what steps will be taken if reversion occurs or dry eye develops. Since eye shape varies from person to person, it is most reliable to be examined in person and consult with your surgeon before deciding.