What Is The Best Graft for Lower Eyelid Retraction?

Question

Which graft is best for use during surgery for lower eyelid retraction repair: ear cartilage, hard palate graft or Alloderm? Do they all add height and is one proven to have a better long-term outcome? Many thanks.

Kenneth D. Steinsapir, MD · Answer

I personally feel that ear cartilage is a terrible material for this reconstruction. It simply is not sufficiently refined for the purpose. It often makes for a bulky and irregular lower eyelid. Alloderm does not persist. After about 3 to 4 months it is completely removed by the body. If only a temporary space was needed this may be fine. However, if a permanent spacer is needed, then in my opinion, hard palate is the graft material of choice. In most cases that require this type of lower eyelid reconstruction, a lower eyelid spacer is not sufficient. Generally it is also necessary to lift the midface vertically. For this purpose I have for many years used hand carved ePTFE to augment the orbital rim which also serves as a felting material to support the cheek soft tissue. It is generally a mistake of inexperience to attempt to fix lower eyelid without a spacer graft. Canthal surgery will not repair lower eyelid retraction and in many cases the surgeon is surprised to discover that tightening the lower eyelid actually made the situation worse. Hope this information helps.

Guy Cappuccino, MD · Answer

Lower eyelid retraction varies in severity between patients.  I have had good success with alloDerm, but cannot comment on hard palate.  I would not use ear cartilage.

Mitesh Kapadia, MD, PhD · Answer

Each surgeon will have their own preference for graft type based on the severity of the eyelid retraction and their own experience with different procedures. For mild cases, I often use Alloderm, but prefer tarsus from the upper eyelid for more severe cases. Again, this is surgeon preference.

Mahsa A. Sohrab, MD · Answer

There are many different approaches to lower eyelid retraction repair. As far as spacers go, alloderm often works well and has the least amount of morbidity since the surgeon would not have to borrow the tissue from elsewhere in your body. The other two can work well and some feel are superior because they involve using your own tissue. There is no proven better long-term outcome amongst the three options, it all depends on surgeon preference, and all would add height.

Jay M. Pensler, MD - Account Suspended · Answer

There are a number of potential grafts available for eyelid retraction when a graft is necessary.Often a graft is not necessary. There are a number of problems of varying severity which may require a graft and the extent and type of problem would play a significant role in the determination of the type of graft required.

What Is The Best Graft for Lower Eyelid Retraction?

Answers (5)

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