Is a Mid Face Lift Usually Done in Conjunction with Spacer Graft to Address Lower Eyelid Deficiency?

Doctor Answers 8

Spacer graft for lower eyelid reconstruction

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For severe case of ectropion, a lower eyelid spacer graft is often necessary.  We prefer a chondromucsal graft (less painful than a palatal graft) when this is necessary; we have published this technique.

For mild to moderate cases, spacers are often not necessary, but canthal reconstruction often is.  Make no mistake, these cases are quite tricky.  They involve working with scar tissue and some irretrievable loss of normal structures, and the results are often not perfect.  So patients must be prepared that their reconstructions, even in the very best of hands, while almost always better, are often not perfect.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Mid Face Lift in Conjunction with Spacer Graft

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It is very difficult to answer your question without seeing you in person and examining you but spacer grafts and midface lifts are often done in conjunction when there is a severe lower eyelid retraction

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews


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 Mid facelifts are as diverse as the surgeons who do them. The eyes are a unique entity and should be done after the mid facelift to know how much skin is appropriate to address.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

Mid-facelift does not address lower eyelid deficiency

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A midfacelift is not done in conjuncture with a spacer graft.  It is important to have a spacer graft done first so as to address any lower eyelid issues prior to embarking on a midfacelift procedure.  A cheek implant would also be an additional consideration other than a midfacelift.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Lower eyelid retraction

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Usually yes, but not always.  Midface lift recruits anterior lamella (skin layer of the eyelid).  Spacer graft addresses middle and posterior lamella shortening of the eyelid, which is often present with postblepharoplasty eyelid retractions.

Dr Taban

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

Face Lift, Mini Face Lift, The Palmer Celebrity Face Lift, Beverly Hills Face Lift

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No, mid  Face Lifts address the mid section of the face.  Placing grafts along the lower eyelid bony ridge is a separate issue.

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


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Part of the problem with lower lid is midface descent with age. Elevating the midface would give extra support to the lower lid and would reduce the risk of recurrence lower lid ectropion.

Moneer Jaibaji, MD
San Diego Plastic Surgeon

What is the issue in the lower lid?

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You did not state why there was a deficiency of the lower lid.

Unless you have had prior surgery or an unusual anatomy of the lower lid, spacer graft would not be needed.

Dr. Mayl

Fort lauderdale

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

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