For severe case of ectropion, a lower eyelid spacer graft is often necessary. We prefer a chondromucsal graft (less painful than a palatal graft) when this is necessary; we have published this technique.
For mild to moderate cases, spacers are often not necessary, but canthal reconstruction often is. Make no mistake, these cases are quite tricky. They involve working with scar tissue and some irretrievable loss of normal structures, and the results are often not perfect. So patients must be prepared that their reconstructions, even in the very best of hands, while almost always better, are often not perfect.