title: Application of Kuhnt-Szymanowski Procedure to Lower Eyelid Margin Defect after Tumor Resection.
abstract: BACKGROUND
  Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek.
  
  
  OBJECTIVE
  We aimed to report our experience of applying Smith-modified Kuhnt-Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect.
  
  
  METHODS
  We performed Smith-modified Kuhnt-Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. The mean age of patients was 80.0 years. The horizontal widths of the defects ranged from half to two-thirds of the lower eyelid length and the vertical width ranged from 5 to 9 mm.
  
  
  RESULTS
  We obtained good functional and esthetic results in all cases. No patients developed ectropion or lower eyelid distortion, and all patients were satisfied with their results.
  
  
  CONCLUSIONS
  We utilized the procedure for morphological revision as a reconstructive procedure for eyelid margin defect by considering the defect as a morphological deformity of the eyelid margin; thus, donor tissue was not required to fill the defect and we could accomplish the reconstruction simply, firmly, and less invasively.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Ayato
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Mariko
authors.initials: M
authors.lastname: Mochizuki
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Kamimori
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Horiguchi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Rica
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mizuno