What Is The Best Graft for Lower Eyelid Retraction?

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.

Doctor Answers 5

Graft choice

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. 


Mount Airy Plastic Surgeon
5.0 out of 5 stars 73 reviews

It is often not the graft material but the surgeon who make the difference.

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.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 reviews

Graft for Eyelid

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.

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Eyelid Graft

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.

Mahsa Sohrab, MD
New York Oculoplastic Surgeon

Lower eyelid graft

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. 

Mitesh Kapadia, MD, PhD
Boston Oculoplastic Surgeon
5.0 out of 5 stars 147 reviews

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.