Lower Lid Retraction Surgery Correction

I am a male in my mid 40's Over a year ago I had spacer grafts, canthoplasty,and cheek lift to fix my lower lid retraction from prior eyelid surgery years back. I feel my lower lid retraction has been corrected, but the inner part of my lower lid closest to the nose angles up. This only happens when I make certain facial movements. Is this a possible side effect/risk to this surgery and is there anyway to fix this without having major surgery again?


Additional Information Added 8/1/2011

 I just wanted to be clarify that both pictures I posted were taken after my surgery, not before. One pic I'm squinting the other m'm not. I have added two photos prior to surgery just to be clear and actually hope if you do have time to respond again it stays the same response. Sorry, if I was unclear at all. Thanks again.

Doctor Answers 7

Lower lid retraction surgery--can this be better?

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As one other colleague has stated, "Truly, the enemy of good is better!" This is an outstanding result, and while the temptation for surgeons to "feed in" on your dissatisfaction (or at least your considering the possibility that it might be better) may be, at best, our natural tendency to want to help our patients by making things better, it could be at worst, the egotistical and ill-advised belief that your surgeon may not have been "as good" as one of us might be! Hubris at its best.

I would join my colleagues who are telling you that this is a really good result (at least by the photographs you have graciously provided), and that any further surgery may not only fail to improve upon this, but may just make things worse, occasionally horribly so that you may regret ever considering trying to improve upon what you presently have. I note that your original surgery was likely when you were in your 30's, so you already are quite early for most individuals considering eyelid surgery. Leave well enough alone; trust those of us who are giving you this free but good advice!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

More is NOT Better/Lower Eyelid Surgery

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You have a great result from your lower lid retraction surgery.  The small imperfections that you notice are not worth the risks of destroying a fabulous result.


The landing zone for making this better is very small.

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I believe the issue here is that your spacer graft is not tapered as it approaches the nose.  Adjusting this is a vast undertaking for a very small gain and the risk of making things worse.  A personal examination in need to assess what other mechanisms might be operating here. Depending on your motivation, you might find a detailed consultation worthwhile.  However, I would have low expectations that such a personal consultation would lead to the recommendation of more surgery.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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Maybe Botox?

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Your results are good and I agree with the other opinions voiced here that to go in and attempt to modify this result may alter your already fine results.  One consideration you might undertake is placing a very small amount of Botox (1U) in the inner aspect of the eyelid where it angles up when you make certain facial movements.  This would temporarily weaken the eyelid muscle in the area so that it would tend not to contract and angle up.  The benefit of this is Botox will not be permanent so if you do not like it, it will be gone in a matter of months. 

Mikel Lo, MD
Tucson Oculoplastic Surgeon

Revisional lower eyelid retraction surgery

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The spacer graft that you have in your lower eyelid is likely too wide, especially along the nose.  Your lower eyelid needs to be examined.  There is surgery to even out the lower eyelid contour but not without risk.  You have understand the full pros and cons before proceeding with surgery.

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

Lower lid retraction

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You've had a good result with your corrective surgery and the lateral lower lid rectraction appears greatly improved. As a result of the spacer graft and possibly the canthoplasty and resuspension of lower lid, your eyes look smaller and you have narrowing of the medial canthus angle. This is definitely an acceptable result from your corrective surgery and would not recommend further surgical intervention. howevere, if the narrowing of the medial canthus angle appears to be dynamic as you described "only happens when I mahe certain facial movements", you may wish to discuss with your surgeon, a trial of conservative Botox or Dysport treatment of medial orbicularis occuli, levator Labii or nasalis muscle which ever your surgeon feels contributes the most to the action.

Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Correction of lower eyelid retraction

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IMHO, your lower eyelids have a great result from the malposition correction and this slight change is most likely related to that corrective surgery.  You can always bring this up to yopur surgeon but IMHO, I'd avoid any surgical correction.  There's an old saying in surgery "the enemy of good is better" which is a warning to surgeon and patient alike that good is good enough and chasing better with more surgery often makes things worse.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 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.