Prevention of lid retraction after lower lid blepharoplasties

This overview article covers the techniques that aim to prevent lid retraction after lower
blepharoplasties. After a brief review of applied anatomy (anterior, middle, posterior lamella), the causes of
blepharochalasis and of postoperative lid retraction are addressed. Clinical examinations are described that can
detect a candidate at risk.
Preventive measures are described, dealing with patient positioning, approaches (transcutaneous–transconjunctival–combination
of both), incision types, flap dissection (skin–skin-muscle–dermal flaps), muscle suspension
techniques (muscle–muscle, muscle–periosteum), horizontal wedge excisions, lateral (tendon and tarsal) and medial
canthal procedures, CO2 laser skin resurfacing and combinations. These techniques are described and critically
appraised