Reconstruction Pre/Post


Dr. Walrath performs many reconstructive surgeries for treatment of the following problems: lid malpositions, prior complications from cosmetic surgeries, skin cancers, and congenital abnormalities.

Examples of some recent reconstructive surgeries can be found below:


Patient#1 (Preoperative). This patient complained of eyelids that were low and interfering with vision, as well as giving her a tired appearance.

Patient#1 (Postoperative, 3 months). After bilateral upper lid lift (ptosis repair), external blepharoplasty of the upper lids, and external blepharoplasty of the lower lids.


 

Patient#2 (Preoperative). This young man had a progressive droop in the left upper lid.

 

Patient#2 (Postoperative, 1 month). External eyelid lifting performed while the patient was awake and comfortable.


  Patient#3 (Preoperative). This gentleman had droop of the eyebrows and eyelids, along with extra skin.  The outer eyebrows had fallen from their normal attachements.  Simply doing eyelid surgery without brow surgery would have led to an undesirable “low brow” appearance.

Patient#3 (Postoperative, 5 week). Five weeks after droopy lid repair (ptosis repair), upper blepharoplasty, and direct lateral brow lift.  The direct brow procedure involves making an incision right above the eyebrows.  It works well in people with bushy eyebrows.  The incision does take several weeks to heal and become less prominent, but as you can see, at one month the incision is really not visible to the casual observer at this point and will fade further over the coming few months.


Patient#4 (Preoperative). This child was born with a drooping lid on the right which was interfering with normal visual development.

Patient#4 (Postoperative, 1 week). After right sided lid repair (ptosis repair) using the frontalis suspension technique.  Due to congenitally poor eyelid function, the repair involved inserting medical grade silicone rubber bands deep within the eyelid and connected up to the deep forehead tissue.  The forehead / eyebrow provides the extra lift for the eyelid.

Patient#5 (Preoperative). This gentleman complained of eyelids that were low and interfering with vision, as well as giving him a tired appearance.

Patient#5 (Postoperative, 2 months). After bilateral upper blepharoplasty and internal browlift.


Patient#6 (Preoperative). This gentleman complained of eye pain in both eyes and dryness.  His left upper eyelid was drooping.  The eyelids did not close normally due to an underlying medical problem, nor did they open properly.  Our goal was to lift both lower eyelids to improve coverage of the surface of his eye.  In addition, a silicone rubber band was inserted to allow his left upper eyelid to open the eye when he lifted his eyebrow.

Patient#6 (Postoperative, 1 month). After repair of left upper eyelid droop (ptosis) using a silicone rubber band that attached the eyelid to the forehead deep beneath the skin and muscle.  Both lower eyelids were also lifted using collagen implants to improve his dry eye and to protect his vision.  Postoperatively, he has no pain and his eyelids are symmetry.

Patient#7 (Preoperative). This child was born with a droop of the left upper lid (congenital ptosis) that was potentially interfering with her ability to develop normal vision in that eye.

Patient#7 (Postoperative, 3 months). After using a strip of leg tendon (tensor fascia lata) to lift the lid, connecting the eyelid to the forehead.


Patient #8 (Preoperative / Postoperative). This young girl had a history of blepharophimosis syndrome: the eyelids droop, they are shortened horizontally, and there is a fold of tissue along the inside corner of the eyelids that runs from the upper lid down to the lower lid (the “epicanthal” fold). It is no simple matter to reduce this type of tissue webbing.  A montage of the left eye showing the preoperative and postoperative condition is depicted below.

On the right side, the preoperative panel shows the web of tissue leading to the appearance of a small eye (horizontally).  There is very little “white” of the eye visible along the inside corner of the eyelids.  The postoperative panel, to the right, shows the one month postoperative result.  Small changes like this take a lot of work:  hers was a 2 hour surgery involving the placement of wires across the nose connecting the right and left eyelids together, as well as some excision and rearrangement of the webbed tissue.


Patient #9 (Preoperative). This patient had a history of basal cell carcinoma of the left lower eyelid treated with resection and reconstruction using a skin graft.  She came to Dr. Walrath because the inner part of the left lower eyelid was pulling down and was no longer contacting the eyeball.  During his examination, an additional basal cell carcinoma was detected beneath the site of the original tumor (not depicted).

Patient #9(Postoperative 3 months). After the cheek tumor was resected, the defect was repaired with an island pedicle flap and a transconjunctival medial canthoplasty.


Patient #10 (Preoperative). This patient had a history of recurrent melanoma at the junction of the right cheek and nose.  This was formerly treated with a large skin graft. This photo was taken after a dermatologist removed the residual melanoma with the Mohs surgical technique.

 

Patient #10 (Postoperative 3 months). This defect was repaired with 3 local tissue flaps.  She received postoperative injections to reduce scarring and downward pulling on the eyelid.

Patient #11 (Preoperative). This patient had a history of basal cell carcinoma of the left lower eyelid. In this photo, the tumor has already been resected by a dermatologist using the Mohs technique.

Patient #11 (Postoperative 3 months). The lid after reconstruction with a local tissue rearrangement.

 

Patient #12 (Preoperative). This patient had a history of squamous cell carcinoma of the right lower eyelid. In this photo, the tumor has been highlighted.

Patient #12 (Postoperative 6 weeks). The lid after reconstruction with a local tissue rearrangement.  Incisions remain visible but will fade to invisible over the next 3-4 months.

Patient #13 (Preoperative). This patient had a history of basal cell carcinoma of the right lower eyelid. In this photo, the tumor has been highlighted.

Patient #13 (After Mohs, before reconstruction). The tumor has been removed.  Unfortunately, it involved the all layers of essentially the entire lower lid. 

Patient #13 (Postoperative 5 months). The lid after reconstruction with a Hughes Stage I and Hughes Stage II procedures. The surgery involved borrowing the inner layer of the eyelid from the upper lid, and adding a skin graft for the outer layer of the eyelid.  The lids were sewn together for one month, prior to surgical separation.  No further surgical procedures were performed.

Patient #14 (Preoperative). This patient had a history of basal cell carcinoma of the right upper lid. It has been removed.  The defect is outlined in blue.  The proposed skin excision, outlined in red, is necessary for optimal cosmetic outcomes.

Patient #14 (Postoperative, 2 months). The same patient after reconstruction with a skin graft.  The skin graft was obtained from the other side during a simultaneously performed cosmetic upper blepharoplasty.  The blue arrow highlights the boundary of the skin graft — this will fade and become invisible over another three months.

 


Patient #15 (Preoperative). Prior to resection of the skin cancer of the right upper lid.  The skin defect (from ulceration, and from biopsy) is highlighted in blue.

Patient #15 (Preoperative, after Mohs removal of tumor).  The defect is outlined in blue.  The proposed reconstruction involved removal of the entire subunit (depicted in red).

Patient #15 (Postoperative, 2 months). After right upper lid reconstruction with full thickness skin graft and left upper lid cosmetic blepharoplasty.

 

 

Disclaimer:  Please note that each patient heals differently. Note that every single photo on this website is from a patient of Dr. Walrath’s.  These represent personal surgical results.  Some surgeons have used photos on these webpages in the past without permission, when counseling their patients, for their own benefit.  If that has been your experience, kindly contact Dr. Walrath.