Total lower lid reconstruction: technical details.

The main complications of this type of lower lid reconstruction are lash loss or malposition, entropion of the upper lid, upper lid retraction, undue laxity of the lower lid, and lid margin deformities. These can all be avioded by meticulous attention to surgical details and dressing techniques. I believe that this is the best and simplest method of providing a lid of acceptable function and appearance. The advantages of this type of operation are: (1) The new lower lid is constructed of lid tissue including the tarsus and conjunctiva from the upper lid. (2) The function and appearance of the new lower lid are acceptable with practically no tendency to late retraction. (3) The function and appearance of the upper lid need not be interfered with. (4) No external scars are produced except when a lash transplant is done. This transplant leaves a small, hardly noticeable scar in the lower part of the opposite brow. (5) The technique is relatively simple and well within the realm of any well-trained ophthalmic surgeon. The obvious disadvantages are the surgeon's inability to inspect the eye for two to four months and the inconvenience to the patient of having one eye closed for such a long period of time.