Ectropion after blepharoplasty prevention and treatment.

Ectropion is the most common serious complication following blepharoplasty for the correction of baggy eyelid deformity. Although blepharoplasty may be considered one of the most gratifying plastic operations, if an ectropion results it then becomes one of the most distressing to patient and surgeon alike.Ectropion complication of the upper eyelid is very rare. This is mainly due to the anatomy of the upper lid with its larger tarsal plate, which permits rather extensive resection of redundant and sagging skin.Ectropion of the lower lid, on the other hand, is a common and very distressing complication. The most important single cause for this complication is excessive excision of skin, which can and must be prevented in every case.I limit the skin resection in the lower lid to a wedge varying from 4 to 6 mms. below the subciliary incision line in most cases. I may resect as much as 8 mms. in severe cases of atonic and relaxed skin.I feel that with the limited resection of skin and a lateral superior tensioning of the skin and relaxed orbicularis muscle underneath ectropion is preventable even in cases of baggy lids in elderly patients.The principal causes of this complication, its prevention, and management once it has occurred are discussed in detail in this article.