Often the most challenging oculoplastic surgical problems may appear to be quite simple to the untrained eye. Reconstruction of the inner corner of the lower eyelids certainly comes to mind. The smallest amount of wound contracture leads to lower eyelid malposition, as demonstrated below:
The left lower eyelid has previously had a tumor excision and reconstruction with a skin graft. As that skin graft contracted, it pulled that lower eyelid down approximately 2 mm. While 2 mm doesn’t sound like that much of a difference, it should be kept in mind that during our social interactions, we can notice differences of 1 mm when we look into the eyes of our partner during communications.
To compound the problem, during the initial office visit, I diagnosed an additional skin cancer in the area immediately below that portion of the eyelid — now there was going to be a tissue deficiency below the region that was ALREADY being pulled down.
I performed eyelid anchoring through the inside of the eyelid (nerdlings would call this “transconjunctival medial canthoplasty”), as well as a vertical “island pedicle flap” repair of the defect from the second skin cancer. At 5 weeks, you can see the restoration of normal eyelid position (below) — a very favorable result!