What if these problems go untreated or uncorrected?

If a patient has retraction with or without ectropion or entropion, the eye will be overexposed to air. Air is the enemy of the eye and too much air can immediately or gradually create a myriad of problems such as chronic irritation, tearing, mucous, redness, pain, a gritty sensation, and even the breakdown of the cornea itself. In addition, if a patient has entropion, the rolled in eyelid and lashes can rub against the eye which irritate and can damage the eye’s delicate surface. Hollowness can occur in any of these situations due to removal of too much fat.

What is considered the proper lower eyelid position

A correctly positioned lower eyelid will protect the eye and help maintain its health and comfort. The ideal position is for the lower eyelid margin to just graze the iris. The outer corner should be two millimeters higher than the inner corner. All four eyelids should interface appropriately with the eye and act as smooth “windshield wipers,” evenly spreading the moisturizing tears we produce across the exposed surface. This bathes the eye continuously which is essential for eye health and to maintain vision.

What methods are available to correct retraction?

To raise the lower eyelids into the correct position, surgeons have used skin grafts placed on the visible skin surface of the lower eyelid to lengthen it and/or have tried to raise and tighten the lower lid by suturing it at the outer corner. Skin grafts are almost never well matched to the surrounding eyelid skin and therefore are very rarely aesthetically pleasing, particularly for patients concerned about their appearance. Likewise, the tightening of the eyelid at the outer corner is not usually successful and can cause the lower eyelid to fall even lower, much like tightening the belt of a man with a protruding belly will result in his trousers being secured lower on the bulge of his belly rather than higher.

How is the Madame Butterfly Procedure performed? 

The Madame Butterfly procedure along with its many variations was developed by Dr. Norman Shorr to correct the challenging problems of retraction, ectropion, entropion and hollowness and is a better, more predictable option than skin grafts or eyelid tightening in almost all cases.

In the Madame Butterfly procedure, to obtain the slack needed to raise the lower eyelid, the entire cheek and midface is raised. You can see how a few millimeters of “excess” tissue is generated to accomplish this by pushing up on your own cheek with your fingers. This raising is done through a tiny incision at the outer corner of the eyelid in the natural smile crease. Scarring from the previous surgery or surgeries is removed, and adhered layers are separated. A graft is then placed on the inside of the lower eyelid (rather than placing an aesthetically unpleasing skin graft on the outside of the eyelid). This inner eyelid graft can be an alloderm graft or a hard palate graft and acts as a permanent and supple stent or support. Fat which is harvested from the abdomen (through a tiny belly button incision) may be necessary to fill in any hollowness of the lower eyelid area that is not filled in by the raising of the cheek and midface. The lower eyelid is then reconstructed and redraped in the ideal structural, functional and aesthetic position. The only incision made is the tiny incision at the outer corner of the eye, concealed in a natural smile crease and virtually invisible.

The Medical Result of the Madame Butterfly procedure: restored eyelid structure and function. The Cosmetic Bonus of the Madame Butterfly procedure: More beautifully shaped eyes and a higher, fuller, more youthful lower eyelid and cheek continuum.