Restore comfort, symmetry, and natural eye shape with lower eyelid retraction surgery by David Isaacs, MD, a dual-fellowship trained oculofacial plastic surgeon in Beverly Hills. This procedure treats scleral show, eye rounding, eyelid malposition, tearing, and discomfort, often caused by prior surgery or thyroid eye disease. Dr. Isaacs customizes each correction with meticulous, minimally invasive techniques tailored to your anatomy.
Lift and Support the Lower
Eyelid Safely
Lower eyelid retraction occurs when the lower eyelid is pulled downward, exposing more of the white part of the eye beneath the iris (scleral show). This can be due to scarring, excessive skin removal during blepharoplasty, facial trauma, thyroid eye disease, or anatomical factors like flat cheekbones or prominent eyes. The condition often creates both functional and cosmetic concerns, affecting the eyelid’s ability to protect and support the eye.
Lower eyelid retraction surgery is a highly specialized procedure performed by Dr. Isaacs to lift and reposition the lower eyelid. Using a hidden incision on the inside of the eyelid, Dr. Isaacs may release scar tissue, perform a midface lift, or use a spacer graft or implant to restore proper support. Additional techniques, such as canthoplasty or skin grafting, may be used in complex cases. The goal is to restore natural eyelid positioning and improve eye comfort.
Lower Eyelid Retraction Surgery Treats:
- Excessive scleral show beneath the iris
- Downward pulling or tethering of the lower eyelid
- Rounded or widened eye appearance
- Eyelid malposition after previous blepharoplasty
- Eye irritation, dryness, or excessive tearing
- Incomplete eyelid closure or weak blink
- Ectropion or entropion affecting the lower lid
- Eyelid asymmetry caused by trauma or scarring
Your Private Consultation
With Dr. Isaacs
During your 90-minute consultation, Dr. Isaacs takes the time to thoroughly understand your concerns, review your surgical history, and examine the delicate anatomy of your lower eyelids and midface. Using detailed measurements and high-resolution photos, Dr. Isaacs will explain your condition, walk you through your options, and curate a surgical plan tailored to your anatomy and goals. He curates surgical plans that ensure natural results, whether you’re seeking correction after prior surgery or treatment for a medical condition.
Advantages of Lower Eyelid Retraction Surgery:
- Restores a natural, almond-shaped eye contour
- Reduces scleral show and eyelid asymmetry
- Improves eye comfort by minimizing exposure
- Enhances eyelid function and blinking ability
- Corrects complications from prior lower eyelid surgery
- Prevents further irritation, tearing, and dryness
- Reconstructs supportive structures for long-term stability
Dr. Isaacs’ Approach to Lower Eyelid
Retraction Surgery
Dr. Isaacs approaches lower eyelid retraction with meticulous precision and individualized planning. Because every case of eyelid retraction has a unique combination of anatomical and surgical factors, Dr. Isaacs examines the contributing layers and designs a customized solution. Whenever possible, the incisions are hidden inside the eyelid to minimize visible scarring.
Lower Eyelid Retractor Recession
Lower eyelid retractor recession targets the retractor muscles that pull the lower eyelid downward. Through a hidden incision on the inside of the eyelid, Dr. Isaacs carefully releases and repositions the retractor muscles. This helps raise the eyelid and reduce scleral show, while maintaining eyelid mobility and function. It is often combined with other support procedures.
Customized Surgical Planning
Midface Lift
A midface lift repositions the cheek tissues upward, reducing downward tension on the lower eyelid. This lift is performed through a discreet incision, often within the lower eyelid or hairline, and enhances the eyelid-cheek junction while softening hollowing or tear trough deformities. It is an essential step when volume loss or cheek descent contributes to eyelid malposition.
Orbital Rim Implants
When there is insufficient support beneath the eye, Dr. Isaacs may recommend an orbital rim implant. This implant is placed over the infraorbital bone to project the lower eyelid forward and upward. It provides long-term structural support and is particularly effective in patients with a negative vector (recessed cheekbone anatomy) or those with persistent lower eyelid sagging.
Orbital Decompression (For Thyroid Eye Disease)
In patients with thyroid eye disease and prominent or bulging eyes, orbital decompression is used to reduce pressure within the orbit. Dr. Isaacs removes or repositions portions of the bony orbital walls to allow the eye to return to a more natural position. As the eye moves backward, the lower eyelid can rise naturally, reducing retraction and exposure symptoms.
Canthoplasty
Canthoplasty involves tightening and elevating the outer corner of the eyelid (lateral canthus). This procedure helps enhance the structural integrity and aesthetic contour of the eye while anchoring the lower eyelid in a more anatomic position. It also prevents future downward migration and supports long-term correction of retraction and rounding.
Skin Grafts or Flaps
In cases where excessive skin was removed during prior surgery or where significant scarring exists, a skin graft or local flap may be required to restore the eyelid’s length and pliability. Skin is typically harvested from behind the ear or the upper eyelid to ensure a color and texture match. This technique restores eyelid flexibility and allows proper repositioning.
The Madame Butterfly Procedure
Developed by Dr. Isaacs’ mentor, Dr. Norman Shorr, this innovative technique integrates multiple steps into one comprehensive correction. Dr. Isaacs uses a hidden transconjunctival incision to release scar tissue, perform a midface lift, and reconstruct the lateral canthus. The procedure also lifts and supports the lower eyelid using the surrounding tissues and skin.
Lower Eyelid Retraction Surgery FAQs
Will the Incisions Be Visible?
In most cases, Dr. Isaacs uses a hidden incision on the inside of the lower eyelid (transconjunctival approach), leaving no external scars. For patients requiring skin grafts or midface lifting, small external incisions may be placed discreetly in natural creases or behind the ear, with careful closure to minimize visibility.
Is the Surgery Painful or Done Under General Anesthesia?
Dr. Isaacs specializes in performing complex eyelid surgeries under local or twilight anesthesia. You’ll remain comfortable throughout the procedure without the risks of general anesthesia. Postoperative discomfort is usually mild and well-controlled with medication.
How Long is the Recovery Process?
Most patients experience swelling and bruising for 1 to 2 weeks. You can return to light activities within a few days, though full healing and final results may take several months. Dr. Isaacs will provide detailed aftercare instructions and closely monitor your progress.
Schedule Your Consultation
David Isaacs, MD, is a dual-fellowship trained oculofacial plastic surgeon in Beverly Hills, renowned for his surgical precision and dedication to natural results. He specializes in complex eyelid corrections, including revision surgery and repair of lower eyelid retraction. During your consultation, Dr. Isaacs will carefully evaluate your anatomy, explain your options, and design a personalized treatment plan. If you’re experiencing discomfort or cosmetic concerns from lower eyelid retraction, schedule your consultation today.
