Modification of the Mustardé and Hughes methods of reconstructing the lower lid

Reconstruction of the lower lid often is a greater task than originally anticipated in preoperative evaluations. The Mustardé and Hughes methods are commonly used for extensive lower lid reconstruction. Certain difficulties encountered in these methods may be minimized by variations in the basic techniques. Structural support for a Mustardé flap may be provided by a free tarsal conjunctival graft rather than a nasal septal cartilage mucosa graft. Late complications following the Hughes procedure include upper lid retraction and entropion. These may be minimized by removing Mueller's muscle from the flap at the time of the original dissection. The Hughes flap may be lysed in 3 to 4 weeks. Lid margin abnormalities, which occur occasionally, are corrected with minor modifications.