Treatment of post-blepharoplasty lower lid retraction by free tarsoconjunctival grafting

BACKGROUND: Blepharoplasty is probably the most commonly performed facial cosmetic procedure. Despite attempts to prevent its occurrence, post-blepharoplasty lower eyelid malposition with inferior scleral show and corneal exposure can occur, particularly with non-ophthalmologist surgeons. Since a repair must oppose the force of gravity and recurrent scarring, it is often difficult to achieve functional and esthetically pleasing surgical correction. A variety of authors have documented methods to correct post-blepharoplasty lower eyelid malposition. A review of such methods is presented. This is the first paper to analyze results from free tarsoconjunctival grafting specifically in cases of post-blepharoplasty lower lid retraction. METHODS: The present case-series report attempts to examine the efficacy of free tarsoconjuctival grafting in patients with post-blepharoplasty lower lid malposition. Ten patients, ranging in age from 48-75 years (mean = 58.7 years), presented with varied amounts of inferior scleral show and ocular symptoms, including epiphora, dry eye and ocular irritation. Varied amounts of lagophthalmos and superficial punctate keratitis were detected in five eyes and ten eyes, respectively. As described, each patient (20 eyes) underwent bilateral free conjunctival grafting from upper to lower eyelids. RESULTS: After a follow-up interval of 3-32 months (mean = 15 months), all patients experienced a decrease in inferior scleral show and symptomatology. The decrease in inferior scleral show ranged from 0.75 to 3 mm, with an average decrease of 1.61 mm; symptoms of epiphora, dry eye or discomfort persisted in only four eyes. The amount of lagophthalmos and superficial punctate keratitis also decreased postoperatively. Side effects were minimal. INTERPRETATION: We conclude that in the specific case of post-blepharoplasty lower lid retraction, free tarsoconjunctival grafting is both safe and effective.