In the unfortunate event of trauma or eyelid cancer, eyelid reconstruction may be necessary to maintain eyelid function and preserve vision while achieving an aesthetically natural appearance. Eyelid reconstruction, although not as involved as for cancer or trauma, can also come into play with conditions such as droopy eyelids or entropion/ectropion.
The team at Consultants in Ophthalmic & Facial Plastic Surgery utilizes a variety of surgical techniques to obtain the best results.
What is Eyelid Reconstruction?
The most frequent need for eyelid reconstruction is after the removal of skin cancer. On the eyelids, surgical excision is the preferred method
for management of most eyelid and facial skin cancers. The majority of skin cancers on the eyelids are either basal cell or squamous cell carcinomas.
The most effective method for removal of these skin cancers is Mohs’ Surgery. This technique removes the cancer and immediately checks the outer margins of the removed tissue for cancer cells. If the outer ring is clear, the surgery ends. If more cancer cells are found, another ring is taken and checked. This process continues until the sample is free of cancer cells. Mohs’ Surgery offers the advantages of the least tissue removal and the best confidence of complete removal (and lowest chance of recurrence).
Reconstruction is typically performed within one to two days after the Mohs’ Surgery. The complexity of the reconstruction and technique used depends on the size and location of the cancer excision and if a tear duct is involved.
There are three goals for our eyelid reconstructions:
- To return eyelid function
- To provide protection to the eye
- To achieve the best aesthetic results possible
In most cases, skin grafts are required for this procedure. Skin may be taken from behind the ear, from one or both eyelids, the forehead, and other areas of the patient’s body. Another method involves creating a skin flap with skin from a nearby area. This skin stays connected to its original blood supply.
Am I a Candidate for Eyelid Reconstruction?
If you have been told you have skin cancer on your eyelid, you will need reconstructive eyelid surgery. The extent will be dictated by the size of the growth. Also, patients who have suffered an accident that has damaged the eyelid or the surrounding area will also need reconstruction surgery. Patients with droopy eyelids caused by laxity or weakness of the eyelid muscles may require reconstruction, although this procedure is simpler than reconstruction after cancer excision. Patients who develop entropion (the eyelid turns inward) and ectropion (the eyelid turns outward) also need this surgery, with the more straightforward goal of releasing the muscle causing the problem.
Eyelid Surgery Risks
This surgery is generally safe, but, as with all surgeries, there are some risks. Serious complications are rare. The risk of losing vision is estimated to be less than one in 5,000 surgeries. Infections are rare. One possible risk is that a second procedure may be necessary if the first procedure was unable to return full function to the eyelid. Also, when skin grafts are used, there is a risk that the graft will not “take” initially and the procedure may need to be repeated.
Is Eye Reconstruction Surgery Painful?
There is no pain associated with these surgeries, as the patient is either fully anesthetized locally or under general anesthesia. The anesthesia options are dictated by the extent of the surgery.
Unlike cosmetic eyelid surgery, which involves a relatively easy recovery, reconstructive eyelid surgery recovery is more involved. Patients usually need to wear an eye patch for at least the first 24 hours. Recovery may take up to two weeks for the bruising and inflammation to fully subside. From there, the extent of the procedure will dictate the remainder of your recovery.