Prevention of lid retraction after lower lid blepharoplasties: an overview.

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.