A Case of Ectropion Caused by Skin Damage During Lower Blepharoplasty that Was Corrected with a Contralateral Lower Eyelid Skin Graft

Abstract

In lower eyelid transconjunctival blepharoplasty, lower eyelid protrusion is addressed by removing orbital fat via a transconjunctival approach. While this procedure has the advantage of avoiding skin scarring, improper surgical manipulation can lead to skin damage that induces postoperative eyelid contraction and ectropion. We report the case of a 38-year-old woman who developed ectropion after skin damage during blepharoplasty. The postoperative ectropion was treated with an incision beneath the lower eyelid lashes to release the subcutaneous contracture, followed by transplantation with a full-layer skin graft from the opposite lower eyelid to cover the area of skin loss. The graft was secured with gauze and elastic tape. After surgery, the patient had improved left eyelid valgus, and her dry eye symptoms disappeared. No complications were observed. In previous case reports of lower eyelid ectropion surgery, the upper eyelid skin was generally used as the primary graft source. Our excellent results suggest that lower eyelid skin may be a valuable alternative due to its superior color and texture and minimal impact on the appearance of the upper eyelid. However, the method is not recommended for bilateral ectropion and is limited by the small amount of donor skin that is available.

Photos of the patient during revision surgery.

The contracture of the left lower eyelid was incised, and the resulting skin defect was addressed with a fullthickness skin graft from the contralateral lower eyelid. Additional right orbital fat was resected at the same time. (A) Preoperative design. (B) A picture of when the contracture was released. (C and D) Photos taken immediately after surgery before (C) and after (D) tap fixation.