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This is Nakao from Nakao Plastic Surgery.

The condition is called Ectropion, in which the lower eyelid turns outward, resulting in an 'Akanbe'-like appearance.

 

Ectropion can occur due to factors such as:

Weakening of the lower eyelid support with aging

Scar tissue contraction resulting from surgery or injury.

 

The treatment plan is developed with careful consideration of the lower eyelid’s anatomical structure. It involves reconstruction of the Anterior Layer (including the skin and lateral canthal ligament) and the Posterior Layer (such as the conjunctiva).

In this case, scar tissue contraction from previous surgeries was the underlying cause, and multiple procedures were required to reconstruct both the anterior and posterior layers.

 

The anterior layer was reconstructed using Dynamic Canthopexy, where lateral canthal ligament is anchored to the orbital bone through a drilled hole, using a suture for traction.

For the posterior layer, Cartilage was grafted onto the tarsal plate, and a Conjunctival Graft was also performed.

 

More than six months have passed since the surgery, and the improvement in Ectropion has been maintained.

Dry eye symptoms has resolved, and there is no more eye discharge.

 

Dynamic canthopexy is a relatively complex procedure in which a hole is made in the bone and a suture is passed through to provide traction. Ectropion is one of the conditions that is difficult to treat and prone to relapse, but this method is highly effective and has a minimal risk of recurrence.

In most standard Ectropion Surgeries, the Periosteum is often used as the anchoring structure. However, in areas where the periosteum is not very thick, we believe that making a hole in the bone is highly effective.

 

The above was presented at the previous Annual Meeting of the Japanese Society of Plastic and Reconstructive Surgery.

 

If you are struggling with severe Ectropion, please don't hesitate to contact us.