Fourteen-Year Experience in Burn Eyelid Reconstruction and Complications Recurrence: A Retrospective Cohort Study.

BACKGROUND: Loss of vision and other ocular defects are a concern with eyelid burn sequelae. This most commonly progresses from eyelid contracture to cicatricial ectropion and lagophthalmos. When left untreated, these may lead to exposure keratitis, ulceration, infection, perforation, and loss of vision. In the case of full-thickness eyelid burns, release and grafting are required. However, there is a paucity of studies on outcomes in eyelid burn surgery treatment, despite concern for permanent ocular damage or loss of vision. The aim of the study is to describe the complication rates in burn eyelid reconstruction at a single center for 14 years. METHODS: A retrospective cohort study was performed of all patients who had sustained eyelid burns and required reconstruction between April 2009 and February 2023. Medical records were obtained from patients' charts. Collected data include demographics, medical history, type of injury, indication for surgery, procedure performed, and complications. RESULTS: A total of 14 patients and 25 eyelids underwent eyelid reconstruction of the 901 total patients with burn-related injuries requiring plastic surgery reconstruction. These patients underwent 54 eyelid surgeries with a mean follow-up time of 13.1 ± 17.1 months. Patients were 71% men and 29% women, with a mean age of 45.1 ± 15.6 years. In 53.7% (n = 29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. The reconstruction of the upper and lower eyelid alone represented a smaller percentage (25.9% and 20.4%, respectively). On average, the patients received 3.9 ± 3.5 eyelid surgeries. The overall complication rate was 53.7% (n = 29). The most common complication was ectropion (42.6%, n = 23). Other complications included eye injury (25.9%, n = 14), lagophthalmos (24.1%, n = 13), local infection (7.4%, n = 4), and graft loss (5.6%, n = 3). CONCLUSION: Periorbital burns represent a major challenge that may require complex surgical intervention. Full-thickness skin graft remains the standard of care for patients with eyelid burns. However, there is a high incidence of ectropion that may require reoperation. Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment.

Congenital ectropion in Noonan syndrome.

Ten-year-old female patient, with facial dysmorphia, scoliosis, short stature, muscular hypotonia, patent foramen ovale and maturational delay, presented for correction of bilateral congenital ectropion. Ophthalmological examination revealed bilateral lower eyelid ectropion, euryblepharon and lagophthalmos, with a positive Bell's phenomenon. She was treated with full-thickness autologous skin grafts on the lower eyelids with bilateral lateral canthoplasty, resolving the ectropion and improving eyelid occlusion. Subsequently, a genetic study was performed that revealed a mutation in the PTPN11 gene and allowed, together with the clinical picture, to make the diagnosis of Noonan syndrome. Noonan syndrome is a multisystem genetic disorder with a wide variety of phenotypes, which usually presents with ocular and periocular disorders. Eyelid ectropion, a distinctive feature of this patient, is a rare ophthalmological manifestation of this syndrome that can be corrected with full-thickness skin graft and lateral canthoplasty.

Lateral Tarsal Strip versus Tensor Fascia Lata Sling for Paralytic Ectropion: Comparison and Long-Term Outcomes.

BACKGROUND: Paralytic ectropion increases risk for corneal injury in facial palsy patients. Although a lateral tarsal strip (LTS) provides corneal coverage through superolateral lower eyelid pull, the unopposed lateral force may result in lateral displacement of the lower eyelid punctum and overall worsening asymmetry. A tensor fascia lata (TFL) lower eyelid sling may overcome some of these limitations. This study quantitatively compares scleral show, punctum deviation, lower marginal reflex distance, and periorbital symmetry between the two techniques. METHODS: Retrospective review was performed on facial paralysis patients who underwent LTS or TFL sling surgery with no prior lower lid suspension procedures. Standardized preoperative and postoperative images in primary gaze position were used to measure scleral show and lower punctum deviation using ImageJ, and lower marginal reflex distance using Emotrics. RESULTS: Of 449 facial paralysis patients, 79 met inclusion criteria. Fifty-seven underwent LTS surgery and 22 underwent TFL sling surgery. Compared with preoperatively, lower medial scleral show improved significantly with both LTS (10.9 mm 2 ; P < 0.01) and TFL (14.7 mm 2 ; P < 0.01). The LTS group showed significant worsening of horizontal and vertical lower punctum deviation when compared with the TFL group (both P < 0.01). The LTS group was unable to achieve periorbital symmetry between the healthy and paralytic eye across all parameters measured postoperatively ( P < 0.01); and the TFL group achieved symmetry in medial scleral show, lateral scleral show, and lower punctum deviation. CONCLUSION: In patients with paralytic ectropion, TFL sling provides similar outcomes to LTS, with the added advantages of symmetry without lateralization or caudalization of the lower medial punctum. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Preseptal transconjunctival approach in orbital floor fracture repairs to prevent postoperative lower eyelid malposition.

PURPOSE: Lower eyelid malposition can be a complication following orbital floor fracture surgeries. We present our incidence of lower eyelid malposition from a large case series of orbital floor fracture repairs using the 'swinging eyelid' approach and 'hang back' technique. METHODS: A retrospective review of all orbital fracture surgeries at our institution from November 2011 to March 2021 was performed. Primary outcomes included the incidence of lower eyelid malposition by category, the average time to presentation after primary surgery, and reoperation rates among cases with lower eyelid complications. RESULTS: A total of 438 cases that involved repair of the fractured orbital floor were identified. Six patients (1.37 %) developed lower eyelid malposition following primary orbital floor repair. Two patients (0.46 %) developed reverse ptosis of the lower eyelid. Two patients (0.46 %) returned with lower lid cicatricial ectropion. One patient (0.23 %) had postoperative lower eyelid retraction. One patient (0.23 %) had postoperative lower eyelid cicatricial entropion. No cases of lower lid flattening, lower eyelid fat flattening, or eyelid notch was noted. All patients with lower eyelid malposition underwent additional surgeries except one patient with reverse ptosis (83.3 %). The average time to the presentation of postoperative complications from the surgery date was 292.8 days (range = 49 days to 3.5 years). CONCLUSION: Lower eyelid malposition after orbital floor repair is a known complication that can be decreased by employing the 'swinging eyelid' with a preseptal approach and closure by the 'hang back' technique.

The Utility of the Paramedian Forehead Flap in Lower Eyelid Reconstruction.

BACKGROUND: Malignant cutaneous eyelid tumors account for approximately 10% of all cutaneous cancers. Like other cancerous skin lesions, treatment commonly involves excision with wide margins, requiring tissue reconstruction. The use of the paramedian forehead flap (PMFF) has been described for reconstruction of the medial and upper eyelid, but literature is lacking for its use in lower eyelid anterior lamella reconstruction. We present a case series of patients who underwent reconstruction of lower eyelid defects using the PMFF. CASE PRESENTATIONS: We present 2 patients who underwent reconstruction of lower eyelid defects using the PMFF surgical technique. The patients had previous history of lower lid repair with other reconstructive methods because of cancerous eyelid lesions. In addition, both received adjuvant radiation therapy, which led to development of ectropion. Postoperative signs, symptoms, and photographs were collected to monitor outcomes. MANAGEMENT AND OUTCOMES: Reconstructions were performed by the collaborative efforts of a facial plastic reconstructive surgeon and oculoplastic surgeon using a staged PMFF approach. Postoperatively, both patients had significant improvement in ophthalmologic symptoms, particularly ectropion and lagophthalmos. At their most recent follow-up visit, they were satisfied with their functional and aesthetic outcomes. CONCLUSION: The PMFF may be safely used to reconstruct defects of the lower eyelid anterior lamella. In this study, the PMFF has proven to be an excellent option for patients with complications after previous lower eyelid reconstructions or history of radiation therapy. Overall, the PMFF should be considered as part of the surgeon's reconstructive ladder when addressing lower eyelid defects.

Efficacy of the Buried Temporary Suture Tarsorrhaphy: A Novel Technique.

PURPOSE: To describe a buried variation of the temporary suture tarsorrhaphy and determine its efficacy period. METHODS: This retrospective case review includes 11 patients needing corneal protection. Six patients had lagophthalmos from facial nerve palsy, 4 had cicatricial ectropion, and 1 had neurotrophic keratopathy. A total of 14 buried temporary suture tarsorrhaphies (BTSTs) were placed. The duration of the BTST was the main outcome. The corneal status before and throughout the BTST was monitored. The eyelids were examined for any undesired changes from the BTST. RESULTS: The mean duration of the BTST was 97.5 days, with a maximum of 273 days. Aside from one spontaneous dehiscence 5 days after placement, all BTSTs held until intentional removal. Five BTSTs were removed for a more definitive surgical procedure, 6 were removed after resolution of the initial indication, and 2 are still in place as the patient awaits surgery. All cases of keratopathy improved after BTST placement. There were no complications and no undesired eyelid changes. CONCLUSIONS: The BTST is a simple, fast, safe, and effective procedure that can be performed in the clinic or inpatient to immediately improve ocular surface coverage. As a minimally invasive procedure that can easily last several months, the BTST is an excellent option for patients who require more intense intervention than medical management alone. It can also securely bridge patients to a permanent solution such as lateral canthal resuspension.

Reconstruction techniques of the orbit after Brown class III maxillectomy: A systematic review.

This systematic review aimed to evaluate the surgical techniques used for orbital floor reconstruction after Brown class III maxillectomy for cancer. Three databases were searched from January 1990 to January 2022. Of the 614 studies identified, 20 were retained after eligibility assessment. The surgical techniques were classified into four groups: free bone flaps (A), alloplastic implants (B), bone grafts (C), and soft-tissue reconstructions (D). Ectropion and diplopia concerned 42.6% and 6.6% of the patients, respectively. Soft tissue reconstruction was more likely to cause ectropion (17/27), followed by the reconstruction techniques of group B (34/79), group C (26/70), and group A (1/7). Postoperative enophthalmos was identified in 18 patients (9.6%), mostly in group D (5/35), followed by groups B (8/68), A (3/33), and C (2/52). Free bone flaps and alloplastic implants represent good reconstructive options in terms of postoperative ocular parameters.

The surgical management and outcomes of kissing nevi of the eyelids.

PURPOSE: To describe the clinical characteristics, surgical technique, and outcomes in patients with kissing nevi who underwent surgical management in two tertiary referral centers. METHODS: Medical chart review was conducted for all patients who underwent surgical repair in Moorfields Eye Hospital and The Children's Hospital of Philadelphia. Demographics, medical history, lesion characteristics, surgical intervention, and outcomes were collected. Main outcome measures were surgical interventions as well as functional and cosmetic outcomes. RESULTS: Thirteen patients were included. Mean age at presentation was 23.46 years (±19.35,4-61), and the mean number of surgeries per patients was 1.9 (±1.3,1-5). Initial procedure included incisional biopsy in three cases (23%) and complete excision and reconstruction in 10 cases (77%). Surgery involved the upper and lower anterior lamella in all cases, the upper posterior lamella in 4 patients (31%), and the lower posterior lamella in 2 patients (15%). Local flaps were utilized in 3 cases and grafts in 5 cases. Complications included: trichiasis (n = 2, 15%), lower eyelid ectropion (n = 2, 15%), mild ptosis (n = 1, 8%), and upper/lower punctal ectropion (n = 1, 8%). Twelve patients (92%) were satisfied with the final functional and cosmetic outcome. No recurrence or malignant transformation were observed in any patient. CONCLUSION: The surgical management of kissing nevi can be challenging, and commonly includes the use of local flaps or grafts, often requiring multiple interventions. The approach should be based on lesion size and location, proximity and involvement of key anatomical landmarks, as well as individual facial characteristics. Surgical management has a favorable functional and cosmetic outcome in the majority of patients.

Auricular Cartilage Graft for Lengthening Levator Muscle Aponeurosis With Ectropion Correction for Paralytic Lagophthalmos.

BACKGROUND: Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials. OBJECTIVES: The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids. METHODS: Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2). RESULTS: Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm. CONCLUSIONS: The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion.

Lower Eyelid Sling for Primary and Revision Correction of Paralytic Lagophthalmos.

Background: Lateral tarsal techniques alone for lower eyelid correction in paralytic lagophthalmos may yield suboptimal outcomes. Objective: To describe a lower eyelid sling technique for primary and revision correction of lower eyelid ptosis and ectropion and evaluate outcomes as measured by margin reflex distance 2 (MRD2). Methods: A retrospective review of patients with long-standing unilateral paralytic lagophthalmos who underwent primary or revision lower eyelid ptosis correction by sling suspension between January 2016 and August 2020 at a tertiary medical center was performed. Surgical technique is illustrated with video and technical considerations are discussed. Pre- and postoperative MRD2 values were quantified from databased photographs. Results: Thirty-eight patients were included. Eighteen patients had undergone prior procedures for ptosis correction. Lower eyelid symmetry and paralyzed side MRD2 significantly improved after lower lid sling for primary and revision cases (p < 0.05), and improvement was sustained over the study period (mean follow-up duration 13.3 months, range 1-33 months). No postoperative complications occurred. Conclusion: Lower eyelid sling yielded safe, effective, and durable correction of lower eyelid position in a cohort of patients with paralytic lagophthalmos.

Involutional ectropion: etiological factors and therapeutic management.

PURPOSE: Involutional Ectropion is commonly prevalent disorder of eyelid malposition caused by age-related degeneration of the periocular tissues. This study conducted to provide a summary and review of surgical practice for the management of lower eyelid involutional ectropion and enlist various causative factors that explain the pathogenesis. METHODS: The review of literature on risk factors and surgical approaches for involutional lower eyelid ectropion, searched on PubMed from 1980 onwards. RESULT: Multiple factors contribute to horizontal and vertical lower eyelid involutional ectropion. Several surgical practices have been described over the last years to address these factors. Lateral tarsal strip is the most used and effective surgery to treat horizontal laxity. CONCLUSION: Knowledge of various contributing factors and surgical procedures will enable to design the most effective therapeutic management for lower eyelid involutional ectropion. surgical approaches are individualized depending on preoperative clinical evaluation of possible causative factors and concerning the predominant location of the ectropion will result in a high success rate.

Evaluation of the Effect of Subciliary Approaches on Lower Eyelid Position in Infraorbital Rim Fractures.

BACKGROUND: Periorbital fractures are a condition encountered after high-energy trauma in the face region. In the follow-ups after surgical repair, some changes may occur in the lower eyelid. Scleral show, ectropion, entropion, and canthal malposition are the most common complications. In this study, the effect of subciliary soft tissue approaches on lower eyelid position in patients with infraorbital rim fracture was investigated. METHODS: Patients admitted with orbital lower rim fracture between January 2017 and January 2021 were included in the study. A total of 90 patients, 15 patients in each group, were followed up for 6 months. Before the operation, the patients were randomly assigned to the groups by an impartial observer and the surgeons who would perform the operation were informed about the method. The patients were divided into six groups according to the type of soft tissue approach for fracture repair. RESULTS: There were 6 groups in total and each group included 15 patients. The mean age was 41.4 in group 1, 50.6 in group 2, 38.2 in group 3, 36.4 in group 4, 38 in group 5, and 39.9 in group 6. There was no statistically significant difference between the groups in terms of age (p = 0.090), gender distribution (p = 0.835), and smoking (p = 0.685). Ectropion was observed in 14 of 73 male patients and 5 of 17 female patients. Ectropion was observed in 9 of 38 smokers and 10 of 52 nonsmokers. When all groups were evaluated together, the scleral show measurement was 0.072 on the operated side and 0.034 on the healthy side. This measurement was statistically significant (p = 0.000). CONCLUSION: Subciliary skin-only or step incision approaches can be used safely in the exposure of infraorbital rim fractures, but both approaches must be supported by canthopexy.

Association of topical glaucoma medications with lacrimal drainage obstruction and eyelid malposition.

BACKGROUND/OBJECTIVES: Adverse effects of topical glaucoma medications (TGMs) may include development of ocular adnexal disorders. We undertook a study to determine the effect of TGMs on the risk of developing lacrimal drainage obstruction (LDO) and eyelid malposition. SUBJECTS/METHODS: All patients 66 years of age and older in Ontario, Canada initiating TGM and all patients diagnosed with glaucoma/suspected glaucoma but not receiving TGM from 2002 to 2018 were eligible for inclusion in this retrospective cohort study. Using validated healthcare administrative databases, cohorts were identified with TGM and no TGM patients matched 1:2 on sex and birth year. The effect of TGM treatment on risk of surgery for LDO and lid malpositions was estimated using Kaplan-Meier and Cox proportional hazards models. RESULTS: Cohorts included 122,582 patients in the TGM cohort and 232,336 patients in the no TGM cohort. Among the TGM cohort there was decreased event-free survival for entropion (log-rank P < 0.001), trichiasis (P < 0.001), and LDO (P = 0.006), and increased ectropion-free survival (P = 0.007). No difference in ptosis-free survival was detected (P = 0.78). For the TGM cohort there were increased hazards for entropion (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.12-1.37; P < 0.001), trichiasis (HR 1.74, 95% CI 1.57-1.94; P < 0.001), and LDO (at 15 years: HR 2.39, 95% CI 1.49-3.85; P = 0.004), and a decreased hazard for ectropion (HR 0.89, 95% CI 0.81-0.97; P = 0.008). No association between TGM treatment and ptosis hazard was detected (HR 0.99, 95% CI 0.89-1.09; P = 0.78). CONCLUSIONS: TGMs are associated with an increased risk of undergoing surgery for LDO, entropion, and trichiasis.

Intraorbital Fixation Midface Lift.

BACKGROUND: Subperiosteal midface lift provides a comprehensive solution to the soft tissue component of midfacial aging. However, midfacial aging also has a skeletal component that is rarely addressed with conventional mid-facelift techniques. Moreover, many of the adverse outcomes after a mid-facelift are closely related to failures and limitations of mid-face fixation. The author's technique was designed to overcome these limitations. OBJECTIVES: The author aimed to describe the rationale, technical details, and outcomes of the author's mid-facelift technique with intraorbital fixation. METHODS: This study was a retrospective review of 82 nonconsecutive cases where the intraorbital fixation mid-facelift was performed by the author between September 2016 and December 2021. Patient data were obtained from patient records and standardized photography. Preoperative differences in mid-face volume were assessed utilizing the Allergan midface volume deficit scale on standardized photography. RESULTS: The average mid-face volume deficit score significantly improved after surgery. Failure of fixation, flat midface deformity, and relapse of mid-face ptosis were not seen in any of the primary patients. Infraorbital hollow did not recur in any of the patients operated on with this technique. None of the primary patients (0/58) in this series developed ectropion or permanent lower eyelid malposition. CONCLUSIONS: Intraorbital fixation mid-face lift is an effective and durable surgical option for the treatment of midfacial aging. The technique is applicable in problem cases such as negative vector patients, negative canthal tilt patients, male patients with large bags, and secondary lower blepharoplasties where conventional techniques tend to fail.

Evaluation of outcomes of lower eyelid entropion and ectropion surgical repair.

<b><br>Introduction:</b> The imbalance of external and internal forces acting on the lower eyelid can result in entropion and ectropion, both of which cause ocular irritation and loss of proper eye protection. Potential complications of untreated cases include recurrent inflammation of the conjunctiva and cornea, conjunctival neovascularization, corneal abrasion or perforation, and ultimately even loss of vision. Although various surgical techniques are used to address this problem, their long-term outcome and effectiveness are still under discussion. </br> <b><br>Aim:</b> To evaluate outcomes of surgery for entropion and ectropion, including a modified Wheeler's method for entropion correction.</br> <b><br>Methods:</b> A non-comparative study (prospective and retrospective groups) included 100 patients operated on in two university hospitals' plastic surgery departments for lower eyelid entropion or ectropion, following formal ethics approval. The prospective group included 50 patients assessed preoperatively and at 3 and 12 months postoperatively. The retrospective group was comprised of 50 patients (2012-2018), whose preoperative documentation and clinical examinations were analyzed. The main outcome measures were change between pre- and postoperative patient-reported symptoms (VAS scale), ectropion/entropion grading scale (EGS/EnGS), quality of life (WHOQOL-BREF), and occurrence of complications.</br> <b><br>Results:</b> The differences in the severity of all symptoms before and after surgery evaluated with the VAS scale were statistically significant in both groups (p <0.05). We observed 6 recurrences (12%) in the prospective group and 9 (18%) in the retrospective group, with minor complications. Very good functional and esthetic postoperative results were confirmed in 70% (79) of the whole group and in 13 patients (81.3%) treated with the modified Wheeler's method. In the prospective group, the Mann- Whitney U test for dependent variables revealed significant improvement in the somatic, psychological, and environmental domains, with no significant change in the social relationships domain.</br> <b><br>Conclusions:</b> The results following entropion/ectropion surgery prove the effectiveness of the methods used. Complementing them with the modified Wheeler's method brought an increase in the number of very good outcomes. Surgery of lower eyelid malposition contributed to reduced symptoms and improved quality of life. The rates of postoperative sequelae were low.</br>.

Ageing increases risk of lower eyelid malposition after primary orbital fracture reconstruction.

Lower eyelid malposition (LEM) is a common sequela after orbital fracture reconstruction. This study aimed to analyse the development of LEM, specifically ectropion and entropion, following primary orbital fracture reconstruction, to identify predictive factors for LEM, and to assess the effect of the eyelid complication on patients' daily lives. The retrospective cohort comprised patients who had undergone orbital floor and/or medial wall fracture reconstruction for recent trauma. Demographics, fracture type and site, surgery and implant-related variables, follow-up time and number of visits, type and severity of LEM, subsequent surgical correction, and patient satisfaction, were analysed. The overall occurrence of LEM was 8%, with ectropion in 6% and entropion in 2% of patients. Older age, complex fractures, transcutaneous approaches, preoperative traumatic lower lid wounds, and implant material were associated with the development of LEM. Of all patients, 3% needed surgical correction of LEM. Six of the 13 patients (46%) who developed LEM required surgical correction. The transconjunctival approach and patient-specific implants should be preferred, especially in elderly patients and those with more complex fractures. LEM often requires subsequent surgical correction, and the treatment period is substantially prolonged, with multiple extra visits to the clinic.

Autologous fat grafting for the correction of cicatricial ectropion.

BACKGROUND: Cicatricial ectropion can be corrected by invasive surgical modalities such as full-thickness skin graft, lateral tarsal strip procedure, etc., which are associated with donor site morbidity and additional scars. Use of autologous fat graft (AFG) in treatment of burn scars has previously shown encouraging clinical results as to skin color, texture, and softness. OBJECTIVE: We aim to introduce the use of AFG for the correction of mild to moderate grades of cicatricial ectropion of the lower eyelid in adult patients. METHODS: This was a prospective, interventional, non-comparative, pilot study including 5 patients with a cicatricial ectropion of grade I-III. All these patients underwent a pre-injection workup to assess anatomical outcomes (grade of ectropion, vertical palpebral aperture (VPA), lagophthalmos, and eyelid retraction), functional outcomes (dry eye status) and aesthetic outcome (change of scar color, thickness, pain, and consistency). RESULTS: At 6-months follow-up assessment, all patients had improvement in grade of ectropion, significant improvement in VPA and eyelid retraction, and almost complete resolution of lagophthalmos in all the three patients who had pre-injection lagophthalmos. There was a significant improvement in scar color, thickness and consistency on Visual Analogue Score (VAS) with no donor site or systemic complications after the procedure but mild pain on day 1 post-injection at the donor site CONCLUSION: AFG transfer of cicatricial ectropion not only eludes the need of a invasive surgery but provides satisfactory correction with stable outcome with an overall improvement in texture of the scar and has low risk.

Absorbable Suture Anchor Technique: A Method for Postblepharoplasty Lower Eyelid Ectropion Treatment.

ABSTRACT: Postblepharoplasty ectropion is a very complex problem to deal with because its relevance is far to be only a functional complaint. Therefore, the best surgical approach requires both aesthetic and functional consideration. Here, we introduce the absorbable suture anchor technique, which can meet both needs, and its surgical procedure is simple and effective and has excellent stability for long-term results. This series included only ectropion patients caused by lower eyelid blepharoplasty, with or without receiving revision surgery. Forty-seven cases (64 eyes) were treated by a single surgeon through this method. Forty-six patients (97.9%) displayed adequate correction of the eyelid ectropion and a marked degree of improvement both in aesthetic terms and with regard to the functional disorders reported. One patient (2.1%) presented complications but brought under control after drainage and dressing change. His previous symptoms were also largely relieved. Absorbable suture anchor technique is an effective, minimally invasive, and safe method to correct postblepharoplasty ectropion.

In this study, we describe an absorbable suture anchor technique and its outcomes in the repair of ectropion caused by lower eyelid blepharoplasty. From December 2017 to January 2021, 47 patients (64 eyes) with lower eyelid ectropion were treated with this technique (mean age, 43 years; age range, 27­61 years). This series included only patients with ectropion caused by lower eyelid blepharoplasty, with or without revision surgery. Patients were assessed with the Ectropion Grading Scale and distraction test preoperatively. All patients first underwent the release of middle lamellar adhesions and scar tissue, and then, the absorbable suture anchor technique was used to suspend the lower eyelid; 9 patients also underwent eyelid wedge excision because of severe lower eyelid laxity. The success rate was 100% for grade I­III and V ectropion and 95% for grade IV. The overall success rate was 98%. In terms of correction iterations, the success rate 100% for patients undergoing their first reconstructive surgery and 90% for patients who had 1 or more reconstructive surgeries. Surgical success was defined in terms of the Ectropion Grading Scale and clinical examination. One patient (1 eye) developed a lower eyelid tissue infection that was controlled with drainage and dressing changes; his previous symptoms were largely relieved. The absorbable suture anchor technique is an effective, minimally invasive, and safe method for correcting postblepharoplasty lower eyelid ectropion.