A strip of protein under the iris
The white of the eye is visible between the iris and the edge of the lower eyelid. It is by this sign that surgeons most often determine retraction.
CONDITION / FACE
Inversion of the eyelid after blepharoplasty.
Inversion of the eyelid after blepharoplasty is a complication when the edge of the lower eyelid falls or moves away from the eye and the eyes become "round". The eye is dry and watery; the eyelid is corrected, but usually not immediately, but when the tissues have healed.
CONCEPTUAL VISUALIZATION- What it is
- After the operation, the edge of the lower eyelid drooped or turned out, and the eyes became "round".
- How common
- In a series of 264 patients after blepharoplasty through a skin incision, during which the corner of the eye was strengthened each time, surgery to correct the position of the eyelid was required in 3.5%.
- What bothers
- Dryness, lacrimation, photophobia, the eye does not close at night; the appearance of the eyes has changed.
- Who treats it
- A surgeon who performs repeated operations on the eyelids; An ophthalmologist also assesses the condition of the eye.
01 / WHAT IS ITWhy did the eyes become
Why did the eyes become
"round".
During blepharoplasty of the lower eyelids, an incision is made under the eyelashes or on the inside of the eyelid, fat "bags" under the eyes are removed or moved, sometimes a little skin. Sometimes, after such an operation, the edge of the lower eyelid falls lower than it should be: a strip of protein appears under the iris, the outer corner of the eye is rounded, and the look becomes sad.
Doctors call this retraction of the lower eyelid: the edge is lowered, but not everted. If the eyelid also moves outward from the eye, it is ectropion, that is, inside out. After blepharoplasty, these conditions are often combined. There is a separate page about ectropion due to other reasons — age, paralysis of the facial nerve.
Retraction is a complication that surgeons are especially wary of. However, in general, blepharoplasty of the lower eyelids causes few complications, and most functional and aesthetic problems are solved without surgery or by repeated intervention.
Correcting such an eyelid is more difficult than performing the first operation, and the result is not always predictable. Therefore, it is important to discuss in advance with the doctor what can actually be achieved.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
drooping eyelid presents.
In the first weeks after blepharoplasty, swollen, numb eyelids that are difficult to close and tearing are a normal part of healing. What should be alarming is that it does not go away when the swelling is asleep.
"Round", sad eyes
The outer corner of the eye is lowered, the eye socket is rounded, the look seems tired or sad.
Lowering of the outer corner of the eyeDryness and lacrimation
Feeling of sand in the eye, irritation, photophobia; the eye tears, although at the same time it dries up.
The eye does not close at night
In a dream, the eyelids do not close completely, and in the morning the eye is dry and red.
LagophthalmusThe eyelid moves away from the eye
The edge of the eyelid turns outward, the red inner membrane is visible - this is already ectropion.
Ectropion03 / REASONSWhat pulls the eyelid
What pulls the eyelid
down
Usually there are several reasons at the same time. Which operation is chosen for correction depends on which one is the main one.
A scar inside the eyelid
As it heals, the layers inside the eyelid become scarred, and it pulls the edge of the eyelid down.
Too much skin removed
If the skin is removed more than necessary, the outer layer of the eyelid becomes too short and does not allow it to lift.
Relaxed corner of the eye
The eyelid is held by a ligament near the outer corner of the eye. If the ligament is loose and not supported during surgery, the eyelid droops.
Sagging cheek tissue
The eyelid rests on the cheek tissue from below; when they are lowered, the eyelid also slides.
Features of the structure
People in whom the eyeball protrudes forward relative to the cheek, the eyelid is relaxed or slightly lowered even before the operation are more at risk.
Skin incision
Retraction is primarily associated with blepharoplasty through an incision under the eyelashes: this approach increases the risk of drooping of the eyelid.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
If the operation was a long time ago, and the eyelid has fallen gradually, this is a planned situation, it usually does not require emergency care. But in the first hours and days after blepharoplasty, there is occasional bleeding behind the eye: most often in the first 3 hours, sometimes after a few days. Then the bill goes for hours.
103 immediately if:
- suddenly stopped seeing in one or both eyes;
- sudden severe pain in or around the eye;
- pain in or around the eye appeared or worsens after eyelid surgery;
- after surgery on the eyelids, the eye protrudes or became tense;
- after eyelid surgery, the eyelids do not open;
- double vision or impaired vision after eyelid surgery.
Do not delay a visit to the doctor:
On the same day: to the surgeon who operated, and if this is not possible, to the ophthalmologist, if the eye is very red or photophobia appears, or a headache with nausea or vomiting occurs, and if the operation was a long time ago, also when the eye hurts or vision changes. In the coming days: if in the first weeks after the operation the eyelid droops, the eye does not close well, it dries or tears, tell the surgeon about it: they often start with massage and protection of the eye. Planned: if several months have passed, and the eyes remain "round" or constantly dry, make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation and documents
When and what operation was performed, through which incision, was the corner of the eye supported; statement and photo before the operation, if any.
- Measurements
How much protein is visible under the iris and what is the distance from the center of the pupil to the edge of the eyelid. If the protein is visible more than 2 mm, a combination of several methods may be necessary.
- samples
The eyelid is pulled back and pulled up with the hands to understand what exactly is holding it: a loose corner, a scar inside, or a lack of skin.
- Eye examination
Whether the cornea is damaged, how dry the eye is; if necessary, consult an ophthalmologist.
- Photo in standard angles
For operation planning and comparison.
06 / TREATMENTHow to fix
How to fix
drooping eyelid
The tactics depend on how much time has passed since the operation, how much the eyelid is lowered and what exactly is pulling it. Almost half of surgeons treat mild retraction without surgery, and severe retraction is usually treated with a combination of several techniques.
01
The first months
While the tissues are healing.
- Eyelid massage
- In a survey of 196 eyelid surgeons, most (51.3%) recommend massage for early retraction after blepharoplasty, some (25.5%) recommend steroid injections.
- Eye protection
- Moisturizing drops and ointment, at night - sealing the eyelids with a special patch. They relieve dryness, but often only partially.
- Take your time
- More than half of surgeons (54.1%) advise waiting at least six months before operating again.
02
Surgery
The method is selected according to what pulls the eyelid.
- Relaxed corner of the eye
- The outer corner of the eye is strengthened or restored. This is the most common technique: it was named by 27.6% of the responses in the survey of surgeons.
- A scar inside the eyelid
- The scar is dissected, and the eyelid is propped up from below with a spacer - a graft of one's own tissues or other material. Among their own tissues, surgeons most often choose the cartilage of the auricle. According to a systematic review of 19 studies, no material has a clear advantage.
- Mild or severe
- The authors of the 19-eyelid series write that mild retraction can be corrected without grafts, and if the eyelid is lowered by more than 2 mm, a spacer is needed to support it from below.
- Dropped cheek
- Cheek tissues are raised so that the eyelid has support. In a study of 120 such operations, the eyelid was raised equally — with or without a spacer, but with a palatal mucosal graft, reoperations were 33%.
- Own fat
- Lipofilling is the introduction of one's own fat into the lower eyelid. In a study of 94 patients, after one year, the lid margin rose by an average of 1.52 mm and 1.7 mm in the two groups.
03
The result
- What is real
- Retraction correction is difficult, and the result is not always predictable. The main complication of such operations, according to a survey of surgeons, is incomplete correction (35.8%).
- eye
- After surgery, the protection of the eye usually improves. In a series of 48 eyelids after one of the methods of exposing the eye decreased in all cases, and the position of the eyelid improved in 98%.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Inversion and retraction of the lower eyelid after blepharoplasty at Dr. Valikhnovskyi's Institute of Surgery is treated in the direction of "Treatment of complications of aesthetic operations" - in particular, when the first operation was performed in another clinic. The clinic is responsible for eyelid surgery; if the cornea is damaged, it is treated by an ophthalmologist.
CLINIC SERVICE
Treatment of complications of aesthetic operations
Skin necrosis, dehisced wounds, capsular contracture, liposuction irregularities, and gross scarring.
View service
What we do for this condition
- Canthopexy and canthoplasty - strengthen or restore the outer corner of the eye so that the eyelid rises and fits tightly to the eye.
- Lateral tarsal stripe — the stretched eyelid is shortened and fixed to the outer corner of the eye.
- Spacers and grafts — the scar inside the eyelid is dissected, and the eyelid is supported with a cartilage graft or a spacer.
- Mesh materials — in difficult cases, a mesh implant gives the lower eyelid additional support.
- Repeat blepharoplasty — correct the consequences of previous surgery on the eyelids.
- Lipofilling — the patient's own fat is injected under the scar tissue to soften it.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
Publications by topic
- An article on the treatment of ectropion of the lower eyelid with polypropylene mesh materials — Bukovynsky Medical Bulletin, 2025 (DOI).
How treatment works with us
- Photo onlineSend a photo of the eyes directly and from the side and, if available, an extract from the clinic where blepharoplasty was performed.
- ConsultationExamination of the eyelids and eye, measurements, samples; if necessary, consult an ophthalmologist.
- PlanWhat is pulling the eyelid - the corner of the eye, a scar, a lack of skin or a drooping cheek - and whether it is worth waiting.
- SurgeryTechniques are selected according to the reason, often combining several.
- RecoverySwelling and tearing in the first days; the doctor will explain how to care for the eye and when to come for an examination.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
After blepharoplasty, the eyes became "round". Will it pass?
In the first weeks, swelling and numbness of the eyelids that make them difficult to close are a normal part of healing. If the eyelid remains lowered, they often begin with a massage. Most surgeons advise to plan a repeat operation no earlier than after six months.
How does retraction differ from ectropion?
During retraction, the edge of the eyelid is lowered, but close to the eye. With ectropion, the eyelid also turns outward. After blepharoplasty, they are often combined.
Will the drops help?
Moisturizing drops and ointments protect the eye, but dryness and irritation are often only partially relieved. They do not change the position of the eyelid.
Can it be fixed without surgery?
Almost half of surgeons (48%) treat mild retraction without surgery — with massage, sometimes with steroid injections. Expressed is usually corrected by surgery.
Will it be possible to completely restore the shape of the eyes?
Not always: correction of retraction is difficult, and the most common complication of such operations is incomplete correction. Sometimes one more step is needed. What can be achieved in you, the doctor will tell after the examination.
Is it possible to be treated at your place if blepharoplasty was done in another clinic?
Yes. The doctor assesses what is now and makes a plan. Take a statement from that clinic and a photo before the operation, if you have them.
What to do if the eye hurts and vision deteriorates immediately after surgery?
Call 103 immediately: it may be bleeding behind the eye. Most often, it happens in the first 3 hours after the operation, but it can also happen after a few days.
Sources
18 sources · systematic reviews, research and NHSshowCollapse
- The evaluation and management of lower eyelid retraction following cosmetic surgeryPlastic and Reconstructive Surgery, 2000doi:10.1097/00006534-200008000-00033 ↗
- Management of Postblepharoplasty Lower Eyelid RetractionFacial Plastic Surgery Clinics of North America, 2019doi:10.1016/j.fsc.2019.07.014 ↗
- Lower Eyelid Blepharoplasty: Minimizing Complications and Correction of Lower Eyelid MalpositionFacial Plastic Surgery, 2023doi:10.1055/s-0043-1761912 ↗
- A Web-Based Survey of Oculoplastic Surgeons Regarding the Management of Lower Lid RetractionSeminars in Ophthalmology, 2019doi:10.1080/08820538.2019.1596290 ↗
- Comparison of Efficacy and Complications Among Various Spacer Grafts in the Treatment of Lower Eyelid Retraction: A Systematic ReviewAesthetic Surgery Journal, 2017doi:10.1093/asj/sjx003 ↗
- Surgical Correction of Cicatricial Lower Eyelid Retraction: A Systematic ReviewSeminars in Ophthalmology, 2024doi:10.1080/08820538.2023.2273850 ↗
- Safety and Complications in Lower Eyelid Blepharoplasty: A Systematic ReviewPlastic and Reconstructive Surgery Global Open, 2025doi:10.1097/GOX.0000000000007102 ↗
- Primary transcutaneous lower blepharoplasty with routine lateral canthal support: a comprehensive 10-year reviewPlastic and Reconstructive Surgery, 2008doi:10.1097/01.prs.0000295377.03279.8d ↗
- Lateral Tarsoconjunctival Flap Suspension Treatment of Post Blepharoplasty Lower Eyelid RetractionOphthalmic Plastic and Reconstructive Surgery, 2020doi:10.1097/IOP.0000000000001699 ↗
- Cheeklift With and Without Posterior Lamellar Spacer Grafts for Treatment of Lower Eyelid RetractionAesthetic Plastic Surgery, 2024doi:10.1007/s00266-024-03950-1 ↗
- Fat Injection as a Valuable Tool for Lower Eyelid Retraction Management: A Retrospective, Observational, Single Blind and Case-Control StudyAesthetic Plastic Surgery, 2023doi:10.1007/s00266-022-03114-z ↗
- Causes and Surgical Outcomes of Lower Eyelid RetractionKorean Journal of Ophthalmology, 2017doi:10.3341/kjo.2016.0059 ↗
- Incidence of postblepharoplasty orbital hemorrhage and associated visual lossOphthalmic Plastic and Reconstructive Surgery, 2004doi:10.1097/01.iop.0000143711.48389.c5 ↗
- Blepharoplasty complicationsPlastic and Reconstructive Surgery, 2010doi:10.1097/PRS.0b013e3181ce17e8 ↗
- Eyelid surgeryNHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/eyelid-surgery ↗
- Vision lossNHS, 2025nhs.uk/conditions/vision-loss ↗
- EctropionNHS, 2025nhs.uk/conditions/ectropion ↗
- Treatment of lower eyelid ectropion using polypropylene mesh materialsBukovyna Medical Bulletin, 2025doi:10.24061/2413-0737.29.2.114.2025.14 ↗
The figures on the page are from these sources.
Eyes became "round"
after blepharoplasty?
Send a photo of the eyes directly and from the side. The doctor will tell what pulls the eyelid down and when it can be corrected.