Skin grafts for upper eyelids - I still don't understand where the pros and cons are, can anyone please explain? (Photos)

Question

Dear doctors, 9 months after an extremely aggressive upper eyelid surgery, it is clear that I need skin grafts before doing any aesthetic reconstructions. Words cannot describe how I regret this unnecessary surgery. I have persistent headaches because my facial muscles are distorted when blinking because my eyelids are too short. Some doctors offer full skin, others work with split skin from the upper arm. I still don't understand where the pros and cons are, can anyone please explain?

Kenneth D. Steinsapir, MD · Answer

You really do not want a skin graft unless nothing else works. Unfortunately, someone will do the thing you are asking for even if it will not accomplish what you really need which is restoration of the eyelid folds.  I image you are very unhappy with the outcome. You will be even more unhappy if you get a skin graft. Many eyelids like yours are short of skin but that is not the real issue. What is really going on is an adhesion between the deeper eyelid structures and the inelastic orbital septum. This causes the eyelid to be tethered to the orbital rim and appear very short. Now it is true that the lid closure can be improved with a skin graft but the result is very unaesthetic. These grafts to not hold make up well and often look like they do not belong to the eyelid (i.e. like a postage stamp was stuck onto the eyelid). The goal needs to be an aesthetic and functional improvement. A physical examination performed at the time of your consultation will allow assessment of what tethering is present and what resources exist for reconstructing the eyelids. These internal scars can often be dissected mobilizing the eyelid platform and improving eyelid closure. At the same time the eyelid crease can be lowered, any ptosis repaired, and the upper eyelid fold reconstructed by mobilizing residual anterior orbital fat. The mobilized fat can also be used to separate the internally scarred eyelid planes that are causing the adhesion. I would most definitely recommend trying this approach to avoid a skin graft if at all possible.

C. Blake Perry, MD · Answer

I’m sorry for the situation you are in. You definitely have lagophthalmos (eyes not closing) following your surgery. Before jumping into a reconstruction, I would try some scar modulation with 5FU and lid stretching. If reconstruction is required, full-thickness skin grafts are your best option in the lid. Best to see an eyelid expert in your area to help. Most importantly, you need to make sure your cornea is staying healthy.

Ilke Bahceci Simsek, MD · Answer

From the photos, I can prefer a skin graft and remove the scar tissue. And also I have to check your cornea for dry eye. You need to see an oculoplastic surgeon to check your eyes and eyelid at the same time for evaluation and treatment!

Zoran Potparic, MD · Answer

Very likely, based on these photos and short of in person evaluation, that you will need a small full thickness graft for one, possibly both upper eyelids. For this reconstruction skin is usually taken from behind the ear since it is closest in color and texture to eyelid skin. Hope this will help.

Mehryar (Ray) Taban, MD, FACS · Answer

You may be candidate for right upper eyelid skin graft which is a reconstructive procedure. You need to see an expert for evaluation and treatment.

Skin grafts for upper eyelids - I still don't understand where the pros and cons are, can anyone please explain? (Photos)

Answers (5)

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

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Skin grafts for upper eyelids - I still don't understand where the pros and cons are, can anyone please explain? (Photos)

Answers (5)

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

Answer: Upper eyelid skin graft

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.