Usefulness of Titanized Polypropylene Mesh and an Anchor System for Correction of Lower Lid Retraction

Because of the lower eyelid's free edge anatomy, it is difficult to preserve its contours after reconstruction. We recently attempted a new operative procedure to treat 2 cases of lower lid retraction by using a titanized polypropylene mesh and an anchor system. As the lower lid skin is elevated laterally in an oblique upward direction, the location of the mesh insertion is decided and the site is marked accordingly. The mesh to be inserted is approximately 20 × 10 mm. A skin incision is rendered from the medial to the lateral side of the lower eyelid edge, and the line of incision is raised beyond the lateral canthus along the skinfold. The mesh insertion site is then developed in the deep fat layer. After hemostasis, the mesh is densely sutured with the fat tissue. Next, the lateral orbital rim is exposed under the periosteum, and 2 anchors, each 2 mm in diameter, are driven into place. The thread connected to each anchor is passed through the mesh and subcutaneous tissue and placed in the lateral orbital rim. Excess skin is trimmed, and the wound is closed. Both patients had complained of dry eye and lacrimation before treatment. No postoperative complications were observed, and in both cases, the symptoms disappeared, and the patient's appearance was improved. During the follow-up period, which lasted from 15 to 29 months, elevation of the lower eyelid edge was kept at a favorable level, and neither case exhibited a relapse of retraction.