Ectropion Repair and Direct Brow Lift in Treatment of Squamous Cell Carcinoma

This 81 year old gentleman came to see me because he had poor vision from a drooping brow, and discomfort from a folded out lower lid.  He had a significant history of sun exposure throughout his life and developed an extensive squamous cell carcinoma on the right side of his face.  The removal of this tumor permanently damaged that facial nerve on his right side, which paralyzed facial movements.  This led to:

1. Inability to raise the right brow.

2. Inability to close the right upper lid.

3. Inability to move the midface / cheek area, resulting in downward tension on the lower lid.

4. Loss of right lower lid tone, preventing it from snapping back to its normal position against the eyeball.

Additionally, due to the history of sun exposure, there was chronic damage of the midface and lower eyelid skin, which also acted toward pulling the lid down and away from the eyeball.

A treating physician placed a gold weight in the upper lid at some point, to improve the closure of the lid.  This weight appears to be carelessly placed, as can be seen in the photos, manifesting as a lump that sticks out over the eyelashes.

A preoperative photo of this patient is presented below:

The surgical plan was to lift the right brow with a direct brow lift and to correct the right lower lid with a canthoplasty, as well as a full-thickness skin graft.  It was determined that this graft could easily be obtained from the upper lid on the other side without compromising the left eyelid function — this would provide the best skin match for the graft.  The gold weight in the right upper lid was left alone.

A preoperative photo is depicted below which demonstrates the extent of the excision for the direct brow lift.  

The sideways “M” (called an “M-plasty” for obvious reasons!) allows me to focus the impact of the lift on the inner aspect of the brow without extending the incision any further than necessary.

The patient was seen at 5 months postoperatively and is doing well.  

The skin graft on the right lower lid is well-healed.  There is significantly improved symmetry in his facial appearance, and his vision is better from the brow lift, and the eye is more comfortable from better apposition of the lid against the eyeball.

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