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"Madame Butterfly" procedure: combined cheek and lateral canthal suspension procedure for post-blepharoplasty, "round eye," and lower eyelid retraction.

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Jules Stein Eye Institute, Los Angeles, California.


The most common complication of lower eyelid blepharoplasty is eyelid retraction ("scleral show") of the lateral one-third of the lower eyelid, with associated rounding and inferior displacement of the lateral canthus. A procedure in which the middle lamellar cicatrix is lysed, the lateral canthus reconstructed, and the cheek elevated to provide additional vertical anterior lamellar skin is described. Skin grafting is often aesthetically poor in the lower eyelid and is unacceptable in the upper eyelid. This new procedure may be used to elevate the lower eyelid rather than lower the upper eyelid in cases of post-blepharoplasty lagophthalmos with exposure keratopathy. Thus, the procedure offers cosmetic and functional repair, without the use of skin grafts, for the patient who would normally need upper and lower eyelid skin grafting.

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