Skin graft to correct ectropion after bleph?

I consulted with two Oculoplastic surgeons regarding the ectropion that I now have after lower bleph.. Both stated that too much skin was removed which is what is causing it. One doc seems confident that a skin graft will correct it. My biggest fear is that it will be noticeable. She said that the upper bleph on the same eye was "underdone" therefore she can use skin from the upper lid and that she will put the graft very close to my lower lid so she thinks it will easily blend and heal well.

Doctor Answers 4

Options for ectropion repair after blepharoplasty

Skin grafting is an option. A well-placed Z-plasty is another option in my experience. The healing of the skin in that area can be quite good with very little evidence left behind. Best wishes with your decision.


Charlottesville Oculoplastic Surgeon
5.0 out of 5 stars 3 reviews

Lower eyelid retraction after blepharoplasty

Thank you for your question.  Retraction of the lower eyelid is a potential side effect from lower eyelid blepharoplasty, and one that may occur in the hands of the most experienced surgeons.  Fortunately, the issue may be corrected.  Depending on the exact nature of the problem, skin grafting may be performed and can produce excellent results.  The graft is generally harvested from behind the ear, although an upper eyelid skin graft may work in the hands of a surgeon experienced in that approach.  Other approaches, such as elevation of the upper cheek/ lower eyelid complex, may be considered when indicated, and a question to explore with your surgeon.  

Paul Nazemi, MD
Newport Beach Oculoplastic Surgeon

Lower blepharoplasty complications, scleral show,

As a plastic surgeon I did numerous correction of ectropion of lower lid with skin grafting.

The best choice is the skin graft from behind the ear. The upper lid skin is a very poor material! why? because the skin is too thin, no subcutaneous layer, and after excision the rate of tightening is more than 50% compared with ear skin around 10%! That means that  from upper lid skin, more than 2 cm wide is needed to graft 1 cm in the lower lid and because the skin is thin, half of this graft will shrink after healing! More, the removal of 2 cm wide skin in upper lid will cause a too large defect which will heal with bad scarring and permanent round eye. And the 2 upper lid must be operated for symmetry.

The cause of your sequel deformity is due to a tightening of your orbital septum scar.

A complete checking is necessary with physical examination before any successful repair operation.

Roger Amar, MD
London Plastic Surgeon
4.6 out of 5 stars 5 reviews

Skin graft after lower eyelid blepharoplasty

Unfortunately, I think your doctor is right. A skin graft will be necessary to replace the skin that was lost. Skin borrowed from the upper eyelid will be the best possible match and should be relatively unnoticeable once competely healed. Any incision made on the face will produce some sort of scarring, but in my experience, these particular skin grafts tend to heal very well and be minimally noticeable. 

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.