Hard palette graft vs. Enduragen vs. Alloderm?

Question

Is there hope for fixing drooping lower lids caused by prior lid surgery? I know it will vary with each patient, but what is the approximate life of hard palette graft vs. Enduragen vs. Alloderm? What are the pros and cons of hard palette graft vs. Enduragen vs. Alloderm?

Samuel Baharestani, MD, FACS · Answer

Elaine - lifting the lower eyelids caused by prior lid surgery is a common procedure performed by an oculoplastic surgeon.  There are pluses and minuses to each of the treatment options you mention.  While hard palate grafts usually offer the best cosmetic results because they are your own natural tissue, they do have some downsides, as well.  First, the graft is harvested from the top of the mouth, leaving the exposed area very raw and sometimes painful as it heals.  Also, there are some extra risks to preparing the graft from the donor site in the mouth.  Enduragen is a great substance, but doesn't always give the same natural result as a HPG.  Also, if enduragen is used, usually your surgery does not require general anesthesia.  I have very limited experience with Alloderm, so can't really comment on it.I would recommend for you to see a board certified ophthalmic plastic surgeon for an evaluation and to perform your surgery.  Best of luck!

Mehryar (Ray) Taban, MD, FACS · Answer

For lower eyelid retraction surgery, various internal grafts can be used.  I am not a fan of enduragen but have had great results with hard palate and alloderm.  Alloderm has become my favorite material, especially the newly made thicker alloderms.  They last as long as hard palate.  Hard palate is difficult since it takes a lot longer to heal from (painfully) in your mouth.  See my manuscript that I published on use of alloderm vs hard palate.

R. Laurence Berkowitz, MD · Answer

I have used both for retracted lower eyelids.  It is imperative to identify where the shortage of tissue lies.  If it is lining then hard palate grafts are the most reliable source of lining and support.  Alloderm after healing will often shrink over a year or two and require redo. I have no experience with Enduragen.  Sometimes when lining is sufficient fat grafting will release the scar along the bone and gradually improve.  If there is skin shortage then it is skin you must use.  Needless to say, an examination by a plastic surgeon knowledgeable about lower eyelid problems is in order.

Hard palette graft vs. Enduragen vs. Alloderm?

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Hard palette graft vs. Enduragen vs. Alloderm?

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Everything you need to know about Eyelid Surgery

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