Full-thickness bipedicle flap for total lower eyelid reconstruction.

We describe a technique for total lower eyelid reconstruction utilizing a full-thickness bipedicle flap from the upper eyelid. The levator aponeurosis and Müller's muscle are recessed to avoid upper eyelid retraction. The key to performing this operation is a thorough knowledge of eyelid anatomy and techniques for preserving its microvascular blood supply. The bipedicle flap requires meticulous surgical technique but has many advantages over standard types of total lower eyelid reconstruction, including the following: excellent tissue match and cosmesis are obtained with single-stage reconstruction; distal flaps and grafts are avoided; open palpebral fissure is maintained, resulting in rapid rehabilitation; posterior lamella of tarsus, rather than substitute, is utilized; anterior lamella of functional orbicularis is utilized for support and closure; pedicles suspend and support the eyelid, decreasing lower eyelid retraction, laxity, and ectropion; allows simultaneous reconstruction of canthal defects; and is faster than other forms of total lower eyelid reconstruction. The results of 14 total lower eyelid reconstructions are presented. Minor canthal deformities, the most frequent complication, are easily corrected. This technique should be considered as an alternative to other procedures in cases of total lower eyelid reconstruction.