Background <p>Lower eyelid retraction (LER) affects both aesthetics and eye function, often resulting from surgery, Graves’ orbitopathy, or aging. Various grafting techniques are employed in its correction.</p> Objectives <p>This study aimed to compare the efficacy of autologous dermis and auricular cartilage grafts in treating LER, with primary focus on changes in margin reflex distance 2 (MRD2).</p> Methods <p>This prospective, randomized interventional study included 26 patients with stable LER. Patients were randomly assigned to receive either auricular cartilage or dermis grafts in surgical correction, using a 2-mm graft: 1&#xa0;mm scleral show ratio. MRD2 measurements were taken preoperatively and at several postoperative intervals, with complications and outcomes recorded.</p> Results <p>The study included 35 eyelids from 20 patients, split evenly between the two graft groups. A significant improvement in MRD2 was observed in both groups post-surgery. Group 1 (cartilage) showed a 10% MRD2 increase over six months, while Group 2 (dermis) showed an 18% increment. Complication rates were low, with seven eyelids in the cartilage group developing granulomas. No persistent keratopathy or infection was noted. Dermis grafts exhibited no cysts or contour issues.</p> Conclusions <p>Both graft types were effective for LER treatment, with dermis grafts showing fewer complications and quicker recovery. Recommendations for graft height adjustment may enhance outcomes, particularly in severe cases. Additional techniques like midface elevation could improve results. Further research with a larger sample size is warranted to confirm these findings.</p> Level of Evidence I <p> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>