Objectives: 1. to present the reconstruction method in the lateral and central lower lid defect using midface lift
2. to present the reconstruction method in the medial lower lid defect using local flap
3. to present the experience of lasers after skin graft
Introduction: Clinically, skin defects of the lower eyelids are caused by skin tumors, trauma, and lower blepharoplasty, and local flaps and skin grafts are known as reconstructive methods. Because the lower eyelid belongs to the middle face and is a very cosmetically important position, special consideration for scars is required. According to the location and size of the defect, the author has applied various methods such as mid-face lift, local flap, and skin graft. In this study, I would like to report cosmetically satisfactory result and experience.
Materials / method: From 2010 to 2016, 95 cases of lower eyelid skin defect were included. Causes were classified as cutaneous malignant tumors of the lower eyelid in 37 cases, lower blepharoplasty in 41 cases, benign tumors in 6 cases, and trauma in 11 cases.
For the treatment, midface lift was performed in 49 cases, local flap in 21 cases, and skin grafting in 25 cases. Pigment laser (585 nm pulsed-dye laser, 6.5 J/cm2, 5-mm spot size) was performed 3 times at monthly intervals in the patients who underwent skin grafting.
Results: In cases where the defect was mainly in the central and lateral areas of the lower eyelid, reconstruction using a midface lift was cosmetically satisfactory as it reduced the need for skin grafting, and placed the scar in the subciliary area. If there was a defect on the medial side of the lower eyelid, a local flap using the lower eyelid was performed if possible or a skin graft was used. Local flap using the nose or glabellar area avoided, as it may lead to a cosmetically unfavorable course due to different skin characteristics. In the case of skin grafting, a pigment laser was performed 3 t
Conclusion: In order to obtain a cosmetically excellent result in lower eyelid reconstruction, it is helpful to perform a midface lift or a local flap using the lower eyelid as much as possible. In addition, when skin grafting is unavoidably performed, the cosmetic result can be improved by using a pigment laser.
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