title: The hybrid approach for reconstruction of severely destructed lower eyelids: combination of skin grafting, temporary tarsorrhaphy, and autologous fat grafting for cicatricial ectropion after injection of commercial grade silicone.
abstract: BACKGROUND
  Although silicone injections for permanent soft tissue augmentation were popular in the past, their use has become unduly controversial because of severe complications, mainly caused by injection of illegal silicones by unlicensed practitioners. The delicate local anatomy of the lower eyelid region makes this region particularly susceptible for complications after silicone augmentation including local inflammation, tissue retraction, and consecutive cicatricial ectropion leading to lagophthalmus and ocular surface irritation.
  
  
  METHODS
  This is a case of a 47-year-old patient demonstrating severe lower eyelid destruction with consecutive ectropion after injection of commercial grade silicone in Thailand 5 years prior, leading to chronic granulomatous infections requiring multiple surgical interventions.Our hybrid approach included radical debridement with complete elimination of silicone residues, lateral canthopexy, reconstruction of the entire lower eyelid esthetic unit using a supraclavicular full-thickness skin graft, and temporary tarsorrhaphy followed by 2 sessions of autologous fat graft injections.Although many previous publications mainly focus on individual aspects of lower eyelid reconstruction, we describe a staged reconstructive approach for correction of severely destructed lower eyelid defects with consecutive lower eyelid ectropion.
  
  
  CONCLUSIONS
  The hybrid approach presented here has proven to be a viable surgical strategy for lower eyelid reconstruction, with esthetically appealing results.
authors.affiliation: From the Departments of Plastic-, Reconstructive-, Hand-, and Burn-Surgery, Klinikum Bogenhausen Academic Teaching Hospital, Technical University Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Voigt
authors.forename: Peter Niclas
authors.initials: PN
authors.lastname: Broer
authors.forename: Sarah
authors.initials: S
authors.lastname: Lorenz
authors.forename: Milomir
authors.initials: M
authors.lastname: Ninkovic
authors.forename: Felix
authors.initials: F
authors.lastname: von Spiegel
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D019882:Blepharoplasty / Q000379:methods*; D002921:Cicatrix / Q000601:surgery; D003357:Cosmetic Techniques / Q000009:adverse effects; D004483:Ectropion / Q000601:surgery*; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D012828:Silicones / Q000009:adverse effects*; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D012828:Silicones