Preventing Retraction With Use of Primary Eyelid Spacer Grafts in Cosmetic Lower Lid Blepharoplasty.

Abstract

Lower eyelid retraction is a challenging complication that can develop after a cosmetic lower eyelid blepharoplasty. Factors such as proptosis and negative orbital vector may place patients at a higher risk for developing postblepharoplasty retraction. Rather than addressing this complication after it occurs postoperatively, this study focuses on preventing its occurrence through the use of primary eyelid spacer grafts during the initial blepharoplasty. The goal of this study was to review the outcomes of primary eyelid spacer graft placement during the initial cosmetic lower lid blepharoplasty. A retrospective chart review was performed at Emory Eye Center between January 1, 2014, and January 1, 2022. Patients that underwent lower eyelid blepharoplasty with primary eyelid spacer graft placement were identified and included in the study. Fifteen patients with Hertel measurements of >17 and adequate preoperative and postoperative photographs were analyzed. Fifteen patients with exophthalmometry measurements of >17 and adequate preoperative and postoperative photographs were analyzed. The mean change in marginal reflex distance 2 was 0.19 mm (range, -1.05 to 1.24 mm). Two patients developed eyelid retraction at their long-term follow-up. Both patients developed retraction about 2 years after the initial surgery. Although this study was limited by its retrospective nature and had a small sample size, none of these high-risk patients developed immediate post blepharoplasty retraction. Careful preoperative evaluation should be performed to identify these high-risk patients, and placement of a primary eyelid spacer graft during the initial lower eyelid blepharoplasty should be considered in this population.