Lower Eyelid Lowering Surgery (Sclera-Show Eye Shaping)

Lower Eyelid Lowering Surgery (Sclera-Show Eye Shaping)

Lower eyelid lowering surgery is a cosmetic surgical procedure that widens the vertical dimension of the eye by lowering the lower eyelid at the outer corner (lateral canthus) by a few millimeters, creating a rounded, gentle "sclera-show eye" appearance. It is also called "glamorous line formation." This procedure is suitable for those concerned with upturned eyes or a stern expression, and those who want their eyes to appear larger. It is widely popular particularly in East Asia.

Surgical Mechanism and Anatomical Background

The shape of the outer corner of the eye is determined by the positional relationship between the lateral canthal tendon and the tarsal plate. The steeper the upward tilt of the outer corner (canthal tilt), the stronger the "upturned eye" impression appears, while a downward tilt creates a "drooping eye" appearance. A study published in Archives of Plastic Surgery (2016) reported that incision and re-suturing of the lateral canthal region can extend the horizontal distance between the medial and lateral canthi, thereby enlarging the appearance of the eye (doi: 10.5999/aps.2016.43.4.321). This technique is based on these anatomical principles: the outer lower eyelid is incised, the lateral canthal tendon is re-fixed to an appropriate position, and the lower eyelid margin is gently moved downward.

Surgical Procedure

The procedure is performed under local anesthesia with an operative time of approximately 30–60 minutes for both eyes. An incision of a few millimeters is made from the conjunctival side (inner eyelid surface) or skin side of the outer corner, and the supportive structures of the outer lower eyelid are adjusted and fixed in the appropriate position. Even when the incision is made on the skin side, the scar is designed along the natural eye corner wrinkles, making it nearly imperceptible after healing. Post-operatively, ophthalmic ointment is applied, and protective tape is placed for several days.

Downtime and Recovery Course

During the first 1–2 weeks post-operatively, swelling and bruising occur, particularly around the outer corner of the eye. Bruising typically resolves within 7–14 days. Suture removal is performed 5–7 days post-operatively. A retrospective observational study of lower eyelid lowering surgery published in the Journal of the Korean Ophthalmological Society (2017) reported that appropriate surgical technique selection achieved aesthetic satisfaction in all cases (doi: 10.3341/kjo.2016.0059), demonstrating maintenance of lower eyelid position stability. The final appearance can typically be assessed 3–6 months post-operatively.

Precautions and Risks

Although generally a safe procedure, rare complications include asymmetry in the degree of lateral canthal opening, lateral canthal retraction (scar contracture), and re-narrowing. A study in Archives of Plastic Surgery (2016) demonstrated that surgical design that preserves the lateral canthal angle reduces complications (doi: 10.5999/aps.2016.43.4.316). It is important to discuss the surgical technique and design thoroughly with your surgeon beforehand.

Combination with Other Procedures

Combining with medial canthoplasty (inner canthus shaping) or double eyelid formation allows for a comprehensive approach to harmonizing the overall eye size. It has also been reported that combining with fat grafting can simultaneously improve volume deficiency around the lateral canthus (Plastic and Reconstructive Surgery Global Open, 2016, doi: 10.1097/GOX.0000000000001190).