Copyright © 2015 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc. Purpose: To evaluate the efficacy and longevity of a human-derived, noncadaveric, acellular dermal implant (BellaDerm) as a posterior spacer graft in the correction of lower eyelid retraction, taking into consideration issues associated with the use of acellular dermis such as contraction and potential regression of repairs. Methods: A prospective, nonrandomized clinical study involving the use of BellaDerm as a posterior spacer graft to correct symptomatic lower eyelid retraction secondary to involutional, cicatricial, and paralytic etiologies. Pre- and postoperative margin reflex distance 2 and inferior scleral show (ISS) were measured for each eyelid, and success was defined as a positive eyelid elevation and decrease in ISS. Long-term stability beyond 12 months was evaluated. Resolution of symptoms and postoperative complications were also documented. Results: Fifteen eyelids of 11 patients were included. All eyes showed an improvement in eyelid elevation and decrease in ISS, both of which were statistically significant. The mean improvement in margin reflex distance 2 for all eyelids was 2.2 mm (p<0.0001). The mean decrease in ISS for all eyelids was 1.7 mm (p<0.0001). The average duration of follow up was 15.6 months. Ten eyelids of seven patients had greater than 12 months of follow up (mean 21.9 months), and this subset was evaluated separately to emphasize longevity of results. In this subset, the mean improvement in margin reflex distance 2 was 2.4 mm (p<0.0001), and the mean decrease in ISS was 1.7 mm (p=0.0003). Conclusions: Noncadaveric human acellular dermal tissue is efficacious in treating lower eyelid retraction. BellaDerm produced long-term symptomatic relief and stable clinical correction of lower eyelid retraction secondary to multiple etiologies. These findings contradict the thinking that although acellular dermis is an adequate modality for correction of eyelid retraction, results may be compromised by graft resorption and recurrence of symptoms. Improved biological integrity from live donor harvesting or alternate processing techniques may contribute to the success of this particular acellular dermis.