Disclosure of Relevant Financial Interests for All Authors

University of California Los AngelesDivision of Plastic & Reconstructive Surgery

Reconstruction of the Severely Scarred and Displaced Lower Eyelid Following Violation of All Three Lamellar Planes

Jason Roostaeian, MD, Emil Kohan, MD, Neil Tanna, MD, Henry K. Kawamoto MD, DDS, James P. Bradley, MD

Mattel Children’s HospitalUCLA Ronald Reagan Medical Center

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Disclosure of Relevant Financial Interests for All

Authors“Nothing to disclose”

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Severe Lower Eyelid Scarring

Trilamellar Lower Eyelid Reconstruction

Post-traumatic Lower Eyelid Scar

Traumatic violation of all three lamellae leads to severe scarring

Post-traumatic full-thickness lower eyelid injury

Post-surgical: Trans-conjunctival incision after partial thickness anterior scar

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Objective

Trilamellar Lower Eyelid Reconstruction

Post-surgical Lower Eyelid Scar

Evaluate staged operative approach for symptomatic improvement

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Methods

Trilamellar Lower Eyelid Reconstruction

First Stage:• Palatal Graft

Mid/Posterior lamellae• FTSG Anterior lamella

Second Stage:• Fat grafting Spacer

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Methods

Trilamellar Lower Eyelid Reconstruction

First Stage:• Palatal Graft

Mid/Posterior lamellae• FTSG Anterior lamella

Second Stage:• Fat grafting Spacer

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Methods

Trilamellar Lower Eyelid Reconstruction

First Stage:• Palatal Graft

Mid/Posterior lamellae• FTSG Anterior lamella

Second Stage:• Fat grafting Spacer

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Methods

Trilamellar Lower Eyelid Reconstruction

First Stage:• Palatal Graft

Mid/Posterior lamellae• FTSG Anterior lamella• Canthopexy

Second Stage:• Fat grafting Spacer

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Cadaveric Anatomic Dissection

Trilamellar Lower Eyelid Reconstruction

Cross-section / Reconstruction

Showed consistent anatomy

Tarsal plate=10-12 mm

Palatal graft support

but pliable orbital rim

PG

Cadaver specimens (n=20)

University of California Los Angeles Division of Plastic & Reconstructive Surgery

UCLA Clinical Review

Trilamellar Lower Eyelid Reconstruction

Lower eyelid reconstruction (1999-2008)

(n=52)

1. Ectropion (eversion): 51%

2. Entropion (inversion): 30%

3. Full-thickness Scar: 19% or n=10

Underwent described staged technique

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Results

Trilamellar Lower Eyelid Reconstruction

Mechanism: 75% Full-thickness injury 25% After transconjunctival incision with

partial injury

MVA = 60% Assault = 40%

Preoperative Postoperative

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Results

Trilamellar Lower Eyelid Reconstruction

Timing: 9.1 months after injury (range=6-17 mths)

Procedures: 2.6 required

Preoperative Postoperative

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Results

Trilamellar Lower Eyelid Reconstruction

Symptoms: Preop: Epiphora (90%), tearing (100%), redness

(100%), Blurring vision (80%), dryness (80%) Postop: Epiphora (0%), tearing (0%), redness

(0%), Blurring vision (10%), dryness (20%)

Preoperative Postoperative

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Results

Trilamellar Lower Eyelid Reconstruction

Complications: (40%)

1. Redundant palatal graft (office excision)

2. Partial loss FTSG (healed secondarily)

3. Cellulitis after fat graft (resolved abx)

Preoperative Postoperative

University of California Los Angeles Division of Plastic & Reconstructive Surgery

Conclusions

Trilamellar Lower Eyelid Reconstruction

Our staged approach for reconstruction of scarred/displaced lower eyelid provided symptomatic improvement.

We suggest caution with transconjunctival approach following partial lower eyelid injury.