Commentary on: New Insights Into Physical Findings Associated With Postblepharoplasty Lower Eyelid Retraction

An analysis of the clinical findings in patients referred to a single surgeon with the problem of lower lid retraction following blepharoplasty is welcomed information. The reported series includes 46 patients over almost a 2-year recent period and should be of keen interest to surgeons who perform lower lid blepharoplasty.1 The series reported includes almost 2 patients per month, which is a good sampling of patients with this problem. Commonly recognized problems were present in the series: skin shortage (79%), unaddressed lower lid laxity (62%), and middle lamellae scarring (17%), as well as some not so commonly recognized. A preexisting negative vector (in many cases unrecognized global globe prominence) (65%) is a known pitfall when performing lower lid blepharoplasty. Not so common factors recognized by the author were inferior orbit/lower lid volume deficits (70%) and orbicularis weakness (87%). As indicated in the article, as from my own personal experience, many of these occur in combination, which makes surgical efforts at repair a difficult situation. The author includes descriptions of his methods of quantitation or certification of each problem, which is a worthwhile checklist for any surgeon facing restoration of these patients. They include the following