Causes and Surgical Outcomes of Lower Eyelid Retraction

PURPOSE: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. METHODS: We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. RESULTS: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. CONCLUSIONS: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Evaluation of effectiveness of acellular dermal matrix allograft and subepithelial connective tissue graft in combination with coronally positioned flap in treatment of mutiple gingival recession in aesthetic areas: A case series.

Obtaining predictable and aesthetic root coverage has become an important part of periodontal therapy. Several techniques have been developed to achieve these goals with variable out comes. The aim of this case series was to evaluate the effectiveness of Acellular Dermal Matrix Allograft (ADMA) and Subepithelial Connective Tissue Graft (SCTG) in combination with Coronally Positioned Flap (CPF) in the treatment of Miller’s class I and II multiple gingival recession in aesthetic areas. A total of 10 patients aged between 18 to 40 years were selected for this study, meeting all the criteria for inclusion. Five patients were treated with ADMA and 5 patients with SCTG in combination with CPF. Various clinical parameters were assessed viz. probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), width of keratinized tissue (WKT) at base line and 6 months after surgery. No significant differences in gingival recession, reduction were noted between ADMA and gold standard SCTG. Within limits of this case series, the use of ADMA may represent an acceptable alternative to the SCTG for treating gingival recession. The use of ADMA eliminates the need for the palatal donor site and it involves a less invasive surgery for treating multiple gingival recession. These results suggest that ADMA may be a useful substitute for SCTG to achieve predictable root coverage.