What causes Graft thickening and what can I do to reduce swelling of the lower eyelids? (photo)

This type of swelling represents chronic inflammation specifically from an inflammatory reaction to the xenograft. Tarsys is a bioengineered product intended to be a replacement for the tarsus of the eyelid and is used in eyelid reconstruction. Unfortunately, it causes a chronic, inflammatory reaction in some patients. This leads precisely to the swollen appearance demonstrated in your lower eyelids. Generally I recommend surgically removing these and letting the tissues calm down before performing a definitive reconstruction. The nature of the subsequent reconstruction will very much depend on how the eyelids heal after the inflammatory material is removed. Generally the spacer was placed to address post blepharoplasty lower eyelid retraction. The ultimate reconstruction then will need to address the original lower eyelid retraction plus any additional issues caused then the eyelid heal after remove of graft material that has cause chronic inflammation. Typically is is best to let the eyelid heal for a few months before performing the ultimate repair of the lower eyelids with the appropriate materials.