Lower eyelid retraction with resulting scleral show can occur following a variety of cosmetic procedures, including lower eyelid blepharoplasty. Lower eyelid retraction is most often associated with a dense middle lamella scar tethering the lower eyelid to the orbital rim. We demonstrate a comprehensive and systematic approach for prevention of lower eyelid retraction during each phase of the healing process. Biologic and mechanical techniques are employed intraoperatively, early in the incubation phase, and later in the rehabilitation phase of healing. The overall goal of these techniques is to maintain or reestablish the proper anatomic relation of the three lamellae of the lower eyelid and to establish this relationship during the healing process. With proper identification of problem patients and utilizing these techniques, we have minimized the occurrence of lower eyelid retraction and have maximized our surgical interventions to improve lower eyelid position.
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