Lower Eyelid Retraction: Causes, Treatments, and Expert Correction by Dr. Robert Schwarcz

What Is Lower Eyelid Retraction?

Lower eyelid retraction occurs when the lower eyelid pulls away or droops downward, exposing more of the white part of the eye (sclera) than is typical. This condition doesn’t just affect your appearance—it can also cause discomfort, dryness, irritation, and difficulty fully closing the eye, which may eventually affect vision and eye health if left untreated.

What Causes Lower Eyelid Retraction?

The most common cause of lower eyelid retraction is previous lower eyelid surgery—specifically lower blepharoplasty—which accounts for over 90% of cases Dr. Schwarcz sees.

However, it can also be caused by:

• Trauma to the face or eye area

• Thyroid eye disease or other inflammatory conditions that affect the eye muscles and tissues

• Sun damage, though less commonly

These causes can weaken the structures that support the lower eyelid, making it prone to drooping or sagging. Regardless of the cause, lower eyelid retraction should be addressed early to preserve both aesthetics and eye function.

Dr. Schwarcz’s Approach to Lower Eyelid Retraction

As a specialist in oculoplastic surgery, Dr. Robert Schwarcz has extensive experience correcting lower eyelid retraction, including complex and revision cases. His treatment plans are always tailored to the individual—but here's an overview of his general approach.

Step One: 5-Fluorouracil Injections (5FU)

In certain cases, Dr. Schwarcz begins with an injection of 5-Fluorouracil (5FU). This treatment can help soften scar tissue and improve eyelid mobility, especially when retraction is caused by postoperative scarring or tightness. It’s a low-risk, minimally invasive option that can sometimes improve eyelid position and avoid—or delay—the need for surgery.

Surgical Treatment: Spacer Grafts

When surgical correction is needed, Dr. Schwarcz’s preferred method is the use of a spacer graft, which helps to rebuild and reinforce the lower eyelid structure, supporting it in the correct position.

Two common types of spacer grafts include:

• Hard Palate Graft – Tissue taken from the roof of the patient’s mouth (hard palate), which offers strong, durable support. This graft integrates well with eyelid tissue and creates the necessary tension to correct retraction.

• AlloDerm Graft – A processed, acellular human tissue graft that’s often used in patients who aren’t ideal candidates for harvesting their own tissue. It’s biocompatible and provides a strong scaffold for healing.

Both grafts are designed to reposition the eyelid and tether it into its proper location, improving both function and appearance.

Other Surgical and Non-Surgical Options

In some cases, Dr. Schwarcz may also recommend a mid facelift to further support the lower eyelid and improve overall facial harmony. This is especially beneficial when the cheek and lower eyelid area have descended with age or trauma.

For patients who are not ready for surgery—or need a temporary fix—filler can be injected to help lift the lower eyelid. However, this option does not create a tethering scar, which means it can’t permanently anchor the eyelid in place. While helpful in mild cases, filler is not as effective as surgery for long-term correction.

Recovery After Lower Eyelid Retraction Surgery

Recovery is straightforward but requires care. The initial healing period is about two weeks, during which the eye will be covered with a protective bandage for the first five days. Most patients are able to resume non-strenuous activities after the bandage is removed.

That said, heavy physical activity should be avoided for at least three weeks, as it can put unnecessary strain on the healing tissues.

By 6–12 weeks post-op, most patients begin to see their final result take shape. Subtle refinements and continued healing will occur for up to six months, but the dramatic improvement in eyelid position, comfort, and appearance is often apparent well before then.

Trust Your Eyes to a Specialist

Lower eyelid retraction can be distressing, especially when it’s the result of previous surgery. But with the right treatment and the right surgeon, the problem can be corrected.

Dr. Robert Schwarcz is a recognized expert in eyelid reconstruction and oculoplastic surgery, with offices conveniently located in the Upper East Side of Manhattan and Rye, NY. Whether you’re dealing with post-surgical complications, trauma, or another cause of retraction, Dr. Schwarcz will develop a personalized plan to restore natural function and beauty to your eyes. Click the Request an Appointment button below to schedule your consultation today.