Tarsal-conjunctival advancement flaps for upper eyelid reconstruction.

For subtotal or total upper eyelid reconstruction, a technique combining tarsal-conjunctival advancement flaps from the upper and lower eyelids was used. A tarsal-conjunctival flap was begun just inside the lower lid margin, and was brought into the upper eyelid so that the tarsus formed the new upper eyelid margin. The remaining tarsus and conjunctiva from the upper eyelid were brought forward to join the lower lid flap. On this conjoined tarsal-conjunctival flap, a full-thickness skin graft was placed. Four weeks later, the conjunctival flap from the lower eyelid was separated. The main advantage of this technique is that it provides stability and support for the new upper eyelid margin while keeping the skin and hair from turning in against the globe.