Upper eyelid retraction surgery?

How specific is the surgery/what are the risks of blindess or any other risks? And is it possible for only the lateral to the pupil part of the eyelid be brought done, or will the whole lid be lowered?

Doctor Answers 5

Upper eyelid retraction surgery is a specialized corrective surgery; risks of blindness in all eyelid surgeries extremely low

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Thank you for your question. It seems you’re trying to get some general ideas about upper eyelid retraction surgery, asking how specific, precise, and predictable it is. You asking about the risks of blindness, and if it is possible to just do the lateral part next to the pupil, or does the whole eyelid have to be brought down.

I can give you some understanding of eyelid retraction, and my thought process when I meet a patient and evaluate them for eyelid retraction, and discuss options for surgery. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. Eyelid malposition, whether it’s eyelid ptosis and eyelid retraction, is a significant part of my practice as a cosmetic oculofacial plastic and reconstructive surgeon in practice for over 20 years.

I would ask first about the nature of the retraction. Eyelid retraction is generally associated with thyroid eye disease/Graves’ disease/thyroid-related immune orbitopathy. When that is the cause, you want to know about the stability of the appearance. There are two phases of thyroid eye disease: inflammatory, and fibrotic stage. You want to minimize operating during the inflammatory stage because it’s an active time where the eyelid position can vary. At the fibrotic stage, the eyes and eyelids are more stable, assuming thyroid eye disease is your situation. The other cause of upper eyelid retraction is congenital, meaning you were born with it.

In eyelid retraction surgery, the first line of procedure is a Muellerectomy involving the removal or release of a muscle behind the eyelid called Mueller’s muscle. This procedure typically descends the upper eyelid about 1-2 millimeters. I usually do these procedures under local anesthesia with LITE™ sedation, meaning the patient is awake during the critical point when I’m trying to establish the right height and contour. We’ll actually sit the patient up to see how their eyelid level looks, which is comparable with what we do for ptosis surgery. When it comes to eyelid position, a millimeter can make a difference.

There are other options to bring down the upper eyelid. There’s a procedure called levator muscle recession, and depending on how much the muscle has to be recessed, some type of grafting procedure where a spacer graft is placed in the temporalis fascia between the levator muscle and the tarsus  the backbone of the eyelid). When I have this discussion with the patient, we have to be ready with a plan A, B, and C depending on what I see during surgery so I’ll know what’s more likely the case, and also be prepared with an additional option.

It is important to understand it is possible to customize the procedure. When you’re describing you just want to address the outer part, that is consistent with a term called lateral flare, which is very often associated with thyroid eye disease. So to answer if you can just do the part outside of the pupil, the outer aspect, or the lateral part? Yes, this procedure can be customized, but it depends on how your eye looks intraoperatively, so you need to discuss this with your prospective surgeon.

For the risk of blindness and other issues, I explain to my patients that for any surgery, the first level of risk is bleeding and infection. The chance of blindness is highly unlikely when you think about the possible cause of blindness. There are many potential risks related to vision that can be compromised such as eye exposure, and corneal abrasion that are more likely than blindness. I would say in blepharoplasty- associated or cosmetic eyelid surgery associated risk of blindness, a number that gets thrown around is something like 0.025% which is very rare and highly unlikely, but still needs understanding as part of informed consent. We mitigate these risks with a proper preoperative evaluation from both the medical and ophthalmic point of view. Medically, we want to make sure the risk of excessive bleeding or potential of infection are minimized, and from an ophthalmic point of view, I’ll make sure the integrity of the eye is optimal so the patient can tolerate the surgery.

I think you need a one on one consultation with a doctor to understand what your situation is. The biggest concern for me is about the aesthetic and functional outcome. When you are changing the position of the eyelid, you can have an overcorrection or undercorrection, so in addition to other risks, you may need revision surgery, which is a possibility that can never be eliminated to zero. Every surgeon has to do a revision for their own work sooner or later.  A very famous colleague said if a doctor claims to never do revisions, they’re either lying or not doing surgery. I think that’s very illustrative of the art of surgery: we are dealing with a human being, soft tissue, and trying to maximize the predictability through high level quality surgery, but also dealing with the elasticity of the human body and the variability of healing.  Understanding you have to be prepared, and the doctor can give you a guideline of how often they do revision surgery. Once you are comfortable, move forward with the operation.I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Upper eyelid surgery complications

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thank you for the question.   Improving upper eyelid retraction generally releases the whole upper eyelid and not just one area plus there is discrete scar tissue  and that lateral area for some reason.  As for the risks, blindness is technically a risk but it's exceedingly rare. It's so rare that I've never seen it in my practice nor have I heard of it happening to anyone I know. So the risks are blindness, injury to the eye, failure of the surgery,  infection, I need for further surgery and that sort of thing. Bruising swelling or longer than average healing is not a complication but I an expectation. 

Chase Lay MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 80 reviews

Upper eyelid retraction surgery?

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Essentially there is no risk of blindness. It is possible for limiting as much as possible the lowering of the lateral aspect of the lid to be brought down.

Fred Suess, MD (retired)
San Francisco Plastic Surgeon

Upper eyelid retraction surgery?

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It depends on the cause of upper eyelid retraction, its severity, the eyelid contour, the anatomy, and goals. See following link for more details.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

Eyelid retraction surgery

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There are a few different techniques to lower an upper eyelid that is retracted. One can weaken the muscle (levator) in the upper eyelid and check the position of the eyelid intra-operatively. Another technique is to place a spacer (foreign material like porcine heart lining) within the levator muscle to lengthen the eyelid. The first approach can be done from the front or underside of the eyelid; the second is done from the front. The result of any eyelid retraction surgery with be a lowering down of the entire upper eyelid edge. If there is a lot of lateral flare, or peaking more laterally, a small tarsorrhaphy (sewing the outermost edges of the eyelids together) can help improve the contour even more. Risks of infection are low, typically less than 0.5%. Risk of blindness is exceedingly low. Greater risks are over correction (making the eyelid too low) or under correction (not making it low enough). Make sure to see an experienced oculoplastic surgeon. Good luck!

Katherine Zamecki, MD, FACS
Danbury Oculoplastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.