Eyelid Revision and Reconstruction

There are a number of reasons patients need to undergo eyelid revision and reconstruction procedures. When patients have defects around the eyes in either the face or the mid-face, it is generally caused by a tumor excision or tissue loss after a trauma. Eyelid reconstruction is commonly used to treat these issues. On the other hand, eyelid revision is typically used to treat a patient who has previously had surgery but still have some pulling down of the lower eyelid or pulling upward. The pulling sensation is otherwise known as eyelid retraction.

TREATMENT

A reconstruction is performed when the surgeon places the eyelids back together after an intentional or traumatic defect is present. An example of an intentional defect would be the removal of a cancerous tumor leaving behind a defect. There are several ways a surgeon can reconstruct the periorbital region. Reconstruction can be a surgical procedure where the surgeon uses some adjacent tissue, a tissue graft, or skin grafts from other areas of the face or body.

Revisional surgery is slightly different but typically uses some of the same ideas. However, revision surgery is usually done after cosmetic or reconstructive surgery. Revisions can be treated surgically, non-surgically or a mixture of both techniques depending on the situation.

CANDIDACY

In any surgery, a patient should disclose any medications they are taking as well as discuss their health conditions with the physician before having the procedure.  Some medications such as blood thinners, aspirin, or heparin products can cause hematomas during reconstruction. If this occurs, the blood underneath can cause the skin graft or flap to not adhere correctly. Therefore, a person who is at risk for bleeding may not be a good candidate if a safe plan of action cannot be determined. 

LIMITATIONS

When working around the periorbital structure, a physician must have a great understanding of the orbital rim, medial canthal tendon, lateral canthal tendon, and the periosteum in that region. The limitations consist of the fact that a surgeon must have intricate knowledge of the anatomy of where to properly place and anchor the tissue. There are certain stabilizing points which must be part of the surgery in order to be successful. The tissue must be anchored to these points appropriately in order to avoid drooping, eyelid retraction, and additional surgeries.

In addition, the patient may be limited to what they are capable of doing in regards to downtime and recovery. Extended downtime may occur when a large defect requires several surgeries in a short period of time in order to correct the area of concern. The physician should map out the process during the preoperative surgical planning process with the patient and help the patient understand the upcoming series of procedures.   

RISKS

The main downfall of having eyelid reconstructive surgery is the way it impacts functional ability after the surgery. The eye might be temporarily closed or a patch may need to be worn. A patient's sight can become blurred from the ointment used around the eye. In addition, there is the risk of infection and bleeding which could occur during or after the procedure.

There could be some scarring from the procedure. Many times, the patient believes that the lesion is very small so the resulting incision and scar will be small as well. However, a physician must be very candid with a patient in regards to what the scarring could look like due to the fact that the cancer could have spread causing a much bigger outcome. Also, a patient must realize that they could end up with a bigger defect which could require further procedures.  

RECOVERY

The physician will instruct a patient about their limitations especially if a skin graft was done. A skin graft is very thin so patients who have them are instructed to not bend over or lift anything heavy to avoid a bleed underneath the graft which could cause graft failure. There will be some swelling and bruising for the first seven to ten days. In some instances, stitches may need to be removed after approximately 1 week. After a week, the patient can usually resume their normal activities. The scars from the incisions will be evident at about 4 to 6 weeks. After approximately 9 to 12 months, the scars will improve.

RESULTS

With either revisional or reconstructive surgery, there is the risk of needing additional procedures. When it comes to revisions, many patients opt for one of the nonsurgical scar modulations. One popular option is the use of 5-fluorouracil injections for retraction in the lower lid area. Steroid injections are also an option for attempting revisions non-surgically.   

FINAL THOUGHTS

The most important thing with eyelid revision and reconstructive procedures is to thoroughly educate the patient both pre and postoperatively. The patient must be aware of the possible outcomes and completely understand that they will be closely monitored during numerous follow-up visits. A consultation appointment with a board-certified surgeon will help the patient have a better understanding of what is involved in the procedures.

Written by Cosmetic Town Editorial Team -SP

Based on an exclusive interview with Sean Paul, MD in Austin, TX