Lower eyelid retraction is a complex eyelid malposition with varied causes and anatomic features that make correction of eyelid position challenging. This original study presents a new surgical concept for correction of lower eyelid retraction in a particular patient population: patients with lower eyelid retraction and concomitant reduction in orbicularis strength. All patients included showed (n=29) non-cicatrical eyelid retraction. The procedure is referred to as minimally invasive because it is performed through a small incision of the temporal upper eyelid crease and a hidden transconjunctival approach. Retractor recession is performed through the transconjunctival entry, elevating and suspending the lower eyelid by means of periosteal canthal suspension through the upper eyelid crease incision. In order to save the already compromised orbicularis muscle of this selected patient population, the authors did not use a lower open eyelid or canthal incision. The authors performed a retrospective medical record review, which yielded a mean correction of 1.8mm at 11 months follow-up in the entire patient population. Less correction and more regression was observed in patients with negative-vector eyelids and more significant post blepharoplasty volume depletion. This study suggests that preservation of orbicularis function is likely an important variable in attaining better outcomes in eyelid recession surgery. The authors present a combination of two well-known techniques and conclude this procedure showing promise as a safe and effective means of recessing retracted lower eyelids with orbicularis weakness in a consistent, reproducible and reliable manner.
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Reviewed by Gregor M Bran
The minimally invasive, orbicularis-sparing, lower-eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength.
