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BEFORE
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Patient had previous transcutaneous lower blepharoplasty elsewhere complicated by eyelid retraction. Three previous failed attempts at repair by other surgeons over several years had worsened her condition to a severe state.
(Note: The anatomical structures mentioned below are illustrated here and described in more detail here.)
REPAIR
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1. The lateral canthal tendon was released from the lateral bony rim and the lower eyelid was reflected downward. A transconjunctival incision was made on the back surface of the eyelid into its middle layers, and extensive scar tissue was removed. Tissue shortage in the middle and back eyelid layers was corrected by placement of an Alloderm decellularized tissue matrix spacer graft (shown just prior to being sutured into the eyelid).
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2. To add vertical support, the SOOF (sub orbicularis oculi fat) was lifted (top suture shown attached to the SOOF) and the lateral canthus was resuspended by tarsal strip resuspenison canthoplasty (bottom suture shown attached to the tarsal plate).
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3. Sutures have been pulled towards their final positions to demonstrate the vertical lift on the eyelid and upper cheek just prior to being attached to the lining (periosteum) of the orbital bone.
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BEFORE
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THREE MONTHS AFTER
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Note: The patient later underwent a slight reinforcement of her tarsal strip resuspension to further enhance the result shown above (not shown).
(Surgery performed by Dr. Frank Meronk)
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Actual Surgery Photos
