Correction of lower lid laxity

Abstract

James H. Carraway, MD Michael P. Grant, MD Richard D. Lisman, MD Henry M. Spinelli, MD Dr. Carraway: The first patient is a 54-year-old woman who is distressed by her dry eyes, especially the left (Figure 1). Fourteen months ago she underwent bilateral lower lid blepharoplasty. She has had a total of 8 surgeries to correct the tightness of her lower lids. Dr. Grant, what would be your approach to this patient? Figure 1 This 54-year-old woman is distressed by her dry eyes. Fourteen months ago, she underwent bilateral lower lid blepharoplasty. She has had a total of 8 surgeries to correct tightness in her lower lids. Dr. Grant: She appears to have a skin deficiency in the anterior lamella as well as a middle lamellar contracture, which are causing her symptoms. I would first explore the extent of her symptoms. After 8 surgeries, I would not be quick to suggest another. Even though she is symptomatic primarily on the left, she may ultimately need treatment for both lids. My first option, assuming there was adequate lid support and no significant horizontal laxity, would be to try a full-thickness skin graft to lengthen the anterior lamellae of the lid. I may choose to combine this with a transconjunctival release of the middle lamellar contracture. Dr. Carraway: From where would you obtain the full-thickness graft? Dr. Grant: She appears to have adequate upper eyelid skin for the graft, which would be 5 or 6 mm in height and 20 to 25 mm in length. The graft could be harvested laterally on both upper lids. Dr. Carraway: If you could not obtain adequate skin from the upper lid, what would be the alternate donor site? Dr. Grant: The next best donor site would be postauricular, but the color match would not be as good. …