Small incision preperiosteal midface lift for correction of lower eyelid retraction

Postblepharoplasty lower eyelid retraction is often due to scarring of the middle lamellae and/or vertical shortening of the anterior lamellae. Traditional reconstructive techniques involve a transconjunctival incision combined with a spacer graft. Other techniques involve a subperiosteal midface dissection or limited preperiosteal dissection. Elevation of the midface reduces the gravitational effect of the cheek on the eyelid and recruits skin for the anterior lamella. This study evaluates a technique for correction of lower eyelid retraction using a preperiosteal midface lift via a lateral canthal incision in a series of patients.

Twenty-eight patients (56 eyes) with postblepharoplasty lower eyelid retraction were evaluated. Preoperative evaluations for inferior scleral show, corneal staining, and epiphora were documented. The patients underwent bilateral preperiosteal midface lift and canthoplasty via a lateral canthal incision. Follow-up ranged from 12 to 18 months.

Average preoperative inferior scleral show was 1.96 mm (range, 1-3 mm). Seventy-eight percent of patients had epiphora, and 54% had corneal staining. Average postoperative lower eyelid position was +0.07 mm (range, 0 to +1 mm) above the inferior limbus. Average change in lower eyelid position relative to the inferior limbus was 2.04 mm. In all eyes, the final lower eyelid position was either at the inferior limbus or above it. All eyes had resolution of epiphora and corneal staining. Two patients required revision of lateral canthus on one side to improve symmetry.

Mobilizing the midface in the preperiosteal plane through a lateral canthal incision provides excellent elevation and support of the eyelid. The small incision allows easy access to adhesions along the inferior orbital rim and to the preperiosteal plane beneath the entire midface. Preperiosteal midface lift combined with canthoplasty provides significant improvement of postblepharoplasty lower eyelid retraction.