Resumo

Objectives: The objective of this study is to evaluate the effectiveness and safety of early spacer grafting using Acelluar dermal matrix to lengthen the levator aponeurosis and correct upper eyelid retraction (UER) caused by overcorrection during cosmetic blepharoplasty Introduction: Upper eyelid retraction following cosmetic blepharoplasty results from overcorrection of the levator palpebrae muscle. This condition causes aesthetically unpleasant "surprised eyes" and leads to functional complications such as dry eye, lagophthalmos, and decreased visual acuity. While traditional approaches often delay revision surgery for six months to allow for wound healing, early correction is essential to improve patient satisfaction and prevent long-term corneal damage. Materials / method: Between August 2023 and September 2025, 64 patients exhibiting upper eyelid retraction within three months of cosmetic surgery were enrolled. The procedure involved detaching the levator aponeurosis from the tarsal plate and Müller muscle to release all adhesions. A 1.6-mm-thick AlloDerm matrix was then grafted as a spacer, utilizing 2–3 mm of width for every 1 mm of required correction. The graft was fixed with 6-0 nylon, and final positioning was verified with the patient in a sitting position Results: Among the 64 patients, 50 (78%) achieved satisfactory results with normalized eyelid positions and symmetric eyes. However, 8 patients (12%) experienced blepharoptosis, and 6 (10%) had insufficient correction. The technique effectively reduced adverse effects like dry and surprised eyes. Long-term follow-up at 6 months showed no absorption issues or loss of symmetry. Postoperative complications were resolved through repeat surgery with modified graft sizes or repeat blepharoplasty. Conclusion: Early grafting using AlloDerm is a safe, effective, and relatively simple method for correcting upper eyelid retraction caused by iatrogenic overcorrection. This technique preserves the anatomical structure of the levator aponeurosis and provides a visible "landmark" for easier identification of tissue layers should any future revisions be required.