[Prevention of eyelid retraction following lower blepharoplasty]

This review covers the techniques used to prevent lid retraction after lower blepharoplasties. After a brief overview of the lower lid anatomy (anterior, middle, posterior lamella), the causes of blepharochalasis and of lid retraction are addressed. Clinical examinations are described that can detect a candidate at risk. Many preventive measures are discussed, examining patient positioning, approaches (transcutaneous, transconjunctival, combination), incision types, flap dissection (skin, skin-muscle, dermal flaps), suspension techniques (muscle-muscle, muscle-periosteum, horizontal wedge excisions, lateral and medial canthal procedures), CO2 laser resurfacing and combinations. These techniques are described and critically appraised.