Lower Eyelid Retraction and Scleral Show After Blepharoplasty: Causes and Solutions

Scleral show refers to the visible white part (sclera) beneath the iris when the lower eyelid is pulled down or does not cover enough of the eyeball. While some scleral visibility is normal, excessive scleral show often signals lower lid retraction, a condition where the lower eyelid is unnaturally pulled downward or away from the eye. This may occur naturally with aging, or more commonly, as a complication of lower eyelid blepharoplasty.

The Aesthetics of Ideal Eyes

Before we explore complications, it’s helpful to understand what makes eyes look balanced and attractive:

• 1:1:1 horizontal ratio: The distance between the eyes, eye width, and inner canthal distance should ideally follow a 1:1:1 proportion.

  

• Vertical iris exposure: A youthful and bright gaze typically shows 85–95% of the iris depending on age and gender.

  

• Scleral balance: Excess visibility of the lower sclera gives a tired or anxious appearance—especially seen in scleral show eyes.

  

• Almond shape: Eyes that gently taper at the corners with a slightly lifted outer canthus give a softer, more feminine impression.

What Causes Lower Eyelid Retraction?

Lower eyelid retraction happens when the lower eyelid is pulled down, turns outward or flipped outward, so the white part of the eye shows more than normal.

Lower eyelid retraction and ectropion (eyelid turning outward) can result from:

• Over-resection of skin or fat during lower blepharoplasty
• Scarring and contracture from prior surgery or trauma
• Weakness in lower eyelid support structures
• Inadequate canthal fixation or failure to secure the orbital retaining ligaments

These complications are more common in older patients or revision cases.

Symptoms of Lower Lid Retraction After Blepharoplasty

• Excessive scleral show
• Dry, irritated, or watery eyes
• Tight or pulling sensation
• Visible gap between eyelid and eyeball
• Cosmetic dissatisfaction and loss of confidence

The patient had been taping her left lower eyelid for a year due to ectropion after surgery by an unknown surgeon. The ectropion was corrected at Noonopi Plastic Surgery.

Lower blepharoplasty should not cause lower eyelid retraction. At Noonopi Plastic Surgery, we not only treat this complication when it happens, but also aim to achieve natural, long-lasting, and beautiful results.

How to Fix Scleral Show and Lower Lid Retraction

At Noonopi Plastic Surgery, we offer advanced surgical techniques for lower eyelid retraction correction, including:

1. Canthopexy or Canthoplasty (Lateral Canthal Tightening)

This patient had undergone lower blepharoplasty 10 years ago and came to Noonopi due to a recurrent and severe tear trough deformity. In May, we performed a secondary lower blepharoplasty. However, lower lid eversion occurred on the right eye, so we performed canthopexy on her in July. The lid tone has been well maintained since then.

This technique tightens the outer corner of the eyelid and repositions the lid for better globe apposition.

2. Midface Lift (Cheek Elevation)

By elevating the midface, we reduce the downward pull on the lower lid. This is especially effective for lower lid retraction surgery in aging patients.

3. Pentagon Excision Technique

This is a patient in their 40s who developed right-sided lid eversion after undergoing lower blepharoplasty at Noonopi Plastic Surgery. We performed a revision on January 31, and the scar has since improved well with minimal visibility. In selected cases, this localized skin excision releases the tension that causes the eyelid to retract or scar inward.

How to Prevent Lower Eyelid Retraction

Preventive techniques during blepharoplasty are essential:

• Canthal support (bone fixation) is routinely done for patients with preoperative laxity or high risk of complications.

This patient was elderly and had very poor eyelid elasticity. During the lower blepharoplasty, we performed canthal support by fixing both sides to the periosteum. Because the left eyelid had weaker elasticity, we applied stronger fixation on that side. As a result, the lower eyelid appeared slightly puckered in the early healing stage. This is due to the muscle flap being anchored to the outer corner of the eye. The uneven appearance is temporary and usually improves on its own within 1 to 6 weeks.

• Tissue-preserving techniques reduce trauma and tension.

It is important to reduce the amount of skin excision to minimize wound tension.

• Customized planning based on lid elasticity, scleral coverage, and eye shape.

We also conduct eyelid laxity tests preoperatively to assess retraction risk—pull-down and snap-back tests help us gauge whether supportive procedures are necessary.

Recovery & Support at Noonopi

Scleral show and lower lid retraction are among the most frustrating complications after lower eyelid surgery. Whether it's from poor surgical planning, aggressive tissue removal, or age-related weakening, these issues require detailed evaluation and a personalized correction plan.

At Noonopi Plastic Surgery in Seoul, we specialize in both primary and revision blepharoplasty, helping patients from around the world restore both comfort and confidence in their eyes.

If you’re recovering from lower blepharoplasty complications or experiencing side effects, Noonopi Plastic Surgery offers a range of revision surgery options tailored to your specific condition.

Need help with eyelid complications? Message us via WhatsApp or visit us at Noonopi Plastic Surgery for a consultation.