title: Staged reconstruction of the lower eyelid following tri-lamellar injury: a case series and anatomic study.
abstract: OBJECTIVE
  Lower eyelid scaring and malposition following violation of all three lamellae pose a significant ophthalmologic reconstructive challenge. The purpose of our study was to document a staged approach for this problem using: 1) transconjunctival scar release followed by palatal graft below the tarsal plate and subciliary scar release followed by full-thickness skin graft superficial to the tarsal plate and 2) subsequent autologous fat grafting to the lower eyelid.
  
  
  METHODS
  Cadaveric anatomic dissections were performed. Post-traumatic and post-surgical lower eyelid deformities requiring reconstruction were reviewed and outcome assessment was based on symptomatic improvement, perioperative complications, reoperations and long-term follow-up (> 1 year).
  
  
  RESULTS
  Cadaver dissections demonstrated consistent lower eyelid tarsal plate and lamellar anatomy for the use of palatal graft and skin grafting. Clinically, 75% cases resulted from full thickness traumatic laceration of the lower eyelid or malar region and 25% of cases occurred after transconjunctival incisions were made for zygomatic maxillary repositioning following partial lower eyelid laceration. Preoperative symptoms of: epiphora, tearing, redness, blurry vision and dryness improved in all patients and complete resolution was seen in 63% of patients. Thirty-seven percent of patients had complications: Redundancy of palatal graft, Partial FTSG loss, cellulitis after fat transfer.
  
  
  CONCLUSIONS
  We describe an approach for the scarred and displaced lower eyelid following injury to all three lamellae that provided symptomatic improvement after lower lid scar tissue release, lengthening of the contracted septum, support of the posterior lamellae with a palatal graft and a replacement of anterior lamella with full thickness skin graft.
authors.affiliation: David Geffen School of Medicine at University of California Los Angeles, Division of Plastic and Reconstructive Surgery, Los Angeles, CA 90095-6960, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: Emil
authors.initials: E
authors.lastname: Kohan
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Tabit
authors.forename: Henry K
authors.initials: HK
authors.lastname: Kawamoto
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D019882:Blepharoplasty / Q000379:methods; D002102:Cadaver; D015331:Cohort Studies; D004954:Esthetics; D005143:Eyelids / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology