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