How Skin Grafts are Avoided or Minimized in Eyelid Retraction Repair Surgery

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A man underwent a lower blepharoplasty two years ago, which resulted in lower eyelid retraction. One of the surgeons he visited recommended the use of skin grafts to fix this. He wants to know if skin grafts would be an effective solution; if skin grafts have a tendency to scar; what the possible complications are after skin graft placement, and if the addition of skin grafts will weigh the lower eyelids down even further.

New York oculoplastic and reconstructive surgeon Amiya Prasad, M.D. reviews his concerns in this video, and explains how the common transcutaneous blepharoplasty technique can damage certain structures of the eyelid, which likely lead to his issue; and how he avoids or minimizes skin grafts in the eyelids:

1:28 — Dr. Prasad details his background training in cosmetic oculofacial plastic and reconstructive surgery, as well as his experience as a specialist in eyelid surgery and revision eyelid surgery

2:31 — Why lower eyelid surgery is a deceptively complex procedure; and how a transcutaneous lower eyelid blepharoplasty is performed

3:13 — How the transcutaneous approach to lower eyelid blepharoplasty affects specific structures of the lower eyelid, and the undesirable results that it could give rise to

4:15 — Why Dr. Prasad chooses to avoid using skin grafts in younger individuals with eye retraction

4:41 — How Dr. Prasad assesses a patient and determines if it’s possible to avoid using skin grafts for their case; and an alternative solution to fix eyelid retraction

5:46 — What Dr. Prasad does when a skin graft is necessary

6:04 — How the physical weight of a skin graft is not an issue, but the appearance of it is

6:38 — The role of platelet-rich plasma and extracellular matrix in facilitating speedy healing of the skin grafts; as well as other modalities that help with healing

7:28 — The challenge of achieving the ideal eyelid height with the help of skin grafts

8:16 — Dr. Prasad’s recommendation

8:39 — Why it is critically important to minimize the number of surgeries as much as possible; and how multiple skin grafts only address the front part of the eyelid and not the back part

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