Eyelid Malposition - Scar Excision and Spacer

In the presence of significant scarring, a spacer is required to provide vertical height and stiffness to support either the upper or lower eyelid. Scar excision and spacer placement for eyelid malposition is performed when there is shortening of the vertical height, horizontal laxity, or mechanical distortion from cicatricial changes (ie, scarring) of the eyelid. This surgery repairs eyelids that appear pulled back and/or don't fully close over the eye.

at-a-glance

Eyelid Malposition - Scar Excision and Spacer

avg. recovery
5 weeks
permanence
Is permanent
application
Not Applicable
surgical
Yes
cost
$2000 - $5000

About the Procedure

When there is significant skin foreshortening, then it may be necessary to augment the lower eyelid with a posterior spacer graft or augment the lower eyelid anterior lamella with a small skin graft. Spacers may be made of various materials including hard palate mucosa or myocutaneous flap. These usually leave a reasonable cosmetic result although limited in their extent. If there is a palpable scar band resulting in localized retraction of the eyelid, then a “V-Y” advancement of lower eyelid skin allows some vertical relaxation in exchange for some additional horizontal tightening of the skin. Contour abnormality due to focal scarring of the left lower eyelid is released with a “V-shaped” incision. The eyelid is then able to be elevated to a normal position and the incision sutured in a “Y” configuration. The eyelid is then in a more natural position following the “V-Y” advancement flap. A posterior approach through the conjunctiva and lower eyelid retractors can also be used and allows release and recession of the scar as well as lower eyelid retractors. In cases of significant upper eyelid retraction, a 0.5 mm thick collagen spacer can be interposed between the recessed Müller/levator complex and the superior border of tarsus. Using these spacers can improve the predictability of upper lid retraction repair.

The goal of eyelid retraction repair is to be able to completely close the eye.

Concerns

Eyelid Malposition - Scar Excision and Spacer addresses concerns such as:

Recovery Notes

After surgery, relax for the remainder of the day, preferably elevated. Cold compresses are used continuously while awake and an ophthalmic ointment is applied to the incision several times a day. Pain is minimal and is usually relieved with OTC medication. Do not watch television or read for the next 24 hours. Sutures are removed on the 4th day after surgery. Mild physical activity may begin at 10 days, progressing to full physical activity at 4 weeks. Avoid sun exposure for 6 weeks

Ideal Candidate

The ideal candidate for scar excision and spacer placement for lower eyelid malposition has had a complication caused by excessive skin resection during a lower eyelid blepharoplasty.

Not Recommended For

Scar excision and spacer placement for lower eyelid malposition is not recommended for patients with a tendency to scar. Prior eyelid/vision surgery, eye trauma, glaucoma, blepharitis, and thyroid diseases must be noted.

Side Effects

Side effects from scar excision and spacer placement for lower eyelid malposition may include corneal abrasions, bleeding, and asymmetry.

Pros
  • Correct complications from previous surgery
  • Improve ectropion
Cons
  • Asymmetry

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