Use of biomaterials for paralyzed lower eyelid reconstruction

Facial paralysis often results in retraction, lid lag and malposition of the lower eyelid, with a consequent increased risk of exposure keratopathy. Therefore, repair of the paralyzed eyelid is central to periocular management in patients with facial paralysis. We aim to evaluate current techniques using biomaterials for lower eyelid reconstruction. A review of the literature was conducted, including posterior lamellar anatomy, a review of traditional grafting techniques, and recent advancements in biomaterial-based reconstruction. Biomaterials were categorized as acellular matrices, natural polymers, and synthetic polymers. Their biomechanical properties, integration, and clinical utility were examined in the management of the paralyzed eyelid. We describe our surgical technique highlighting its versatility irrespective of biomaterial graft used. While acellular dermal matrices are the most widely used biomaterials, synthetic polymers, and natural polymers have also been shown to have favorable integration and compatibility for posterior lamellar augmentation and reconstruction. Future directions include application of bioengineered stem cells with regenerative capacity. Biomaterials can provide a viable and effective alternative for posterior lamellar reconstruction in the treatment of paralyzed lower eyelid malposition and retraction. Specifically, acellular matrices offer a balance of support and biocompatibility.