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References
1.Patel BCK, Patipa M, Anderson RL, McLeish W. Management of postblepharoplasty lower eyelid retraction with hard palate grafts and lateral tarsal strip. Plast Reconstr Surg 1997;99:1251–11260.
2.Kim JK, Ellis DS, Stewart WB. Correction of lower eyelid retraction by transconjunctival retractor excision and lateral eyelid suspension. Ophthal Plast Reconstr Surg 1999;15:341–348.
3.Aldave AJ, Maus M, Rubin PA. Advances in the management of lower eyelid retraction. Facial Plast Surg 1999;15:213–224.
4.Kersten RC, Kulwin DR, Levartovsky S, et al. Management of lower-lid retraction with hard-palate mucosa grafting. Arch Ophthalmol 1990; 108:1339–1343.
59
Retroauricular Dermal Spacer Graft
for Lower Lid Retraction Repair
Francesco P. Bernardini
In cases of ectropion/scleral show, another location to harvest valuable tissue that can be used as a posterior spacer to lift the lower eyelid is the retroauricolar area. Harvesting this spacer is quite simple, painless, without visible scar, and well accepted by the patients. It is like harvesting the skin from the retroauricolar region, only in this case we peel off the epidermis instead of the dermis. It is stiff enough to support the eyelid, works like Alloderm (but its cheaper), and avoids the pain and the prolonged healing time of the hard palate graft. I have used it satisfactorily in lower eyelid retraction, especially in patients with thyroid eye disease.
Figure 59.1. Excision of the super cial lay or the skin (epidermis).
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188 F.P. Bernardini
Figure 59.2. Deeper layer (dermis).
Figure 59.3. Dermal graft harvested.
Chapter 59 Retroauricular Dermal Spacer Graft for Lower Lid Retraction Repair 189
Figure 59.4. Dermal graft in position (long-term result).