Lower Blepharoplasty Functional Complications Treatment

“Malposition” is the most common functional complication of lower blepharoplasty. Malposition is a variation of the lower eyelid position, thus interaction with the relationship of eyeball with lower eyelid. This functional complication is due to:

1. Lower eyelid retraction
2. Cicatricial ectropion

Lower eyelid retraction is the pulling down of the eyelid thus exposing white of the eye “excessive sclera”. This excessive sclera creates a surgical looks. This functional complication commonly occurs when blepharoplasty is performed using a transcutaneous incision. The excessive scarring in the middle layers of the eyelid caused retraction. This mainly caused in lower blepharoplasty when transcutaneous approach is used as well as by the excessive skin and fat removal.

The Classical surgical approach for the correction of lower eyelid retraction is quite challenging and may require more than one operation. These are as follow:

1. Scar tissue severing
2. Lateral canthus tightening procedures
3. Dermal fat graft, ear cartilage grafting, hard palate tissue, decellularized tissue matrix called as spacer graft
4. Silicone cheek/orbital rim placement

These classical operations are often for a short duration only. In lower blepharoplasty, orbital fat deficiency has been observed as a major contributor to eyelid collapse.

Cicatrical ectropion is a functional complication in which lower eyelid is pulled away from eyeball. It is a common complication of lower blepharoplasty. Cicatrical Ectropion is caused due to excessive removal of fat and lower eyelid skin and it’s common in transcutaneous lower blepharoplasty. People those have stretched and weakened supporting tendons have high risk especially the smokers because the tightness is poorly tolerated and results in eyelid eversion.

Surgical treatment for cicatricial ectropion includes a difficult reconstructive operation in which grafting of donor skin with full thickness is require. Donor skin is taken from behind the ear. Some tightening techniques may also be required at lateral canthus or midface.