Lowering the Lower Eyelid Procedure

What is the lowering the lower eyelid procedure?

Lowering the lower eyelid (LLL) procedure, also, called lower eyelid shortening, is a surgical procedure to make a large eye opening vertically with a cosmetically desirable shape of the eyes.

Who are suitable for the lowering the lower eyelid procedure?

People seek large oval eyes with following features of the eye shape:

1. An up-slanting appearance of the eye opening, including
   1. Positive canthal tilt < 2mm
   2. A steep inclination of the lateral third of the lower lid margin
2. A high-positioned lower lid margin overriding the lower part of the cornea.

How is the lowering the lower eyelid surgery performed?

LLL procedure is performed by either trans-conjunctiva static shortening of the lower eyelid retractors, or trans-conjunctiva approach + sub-cilliary skin excision.

In RCSS, Dr Xu performs the LLL procedure through a trans-conjunctival approach in most of cases. This approach makes no scars in the skin of the lower eyelids.

LLL procedure takes about 1-2 hours and can be done under local anaesthetics or LA + sedation.

What is possible outcome?

Lowering the lower eyelid procedure was performed as an effective option for patients desiring large oval eyes as an independent or ancillary procedure. Combing LLL procedure with levator-aponeurotic surgery would be the best way to vertically enlarge the eye opening.

What are possible risks and complications?

• Conjunctiva swelling and inflammation
• Lower lid malposition
• Temporary double vision
• The eyelid turning inward toward the eye
• Asymmetry
• Under-correction or overcorrection