Correction of Cicatricial Ectropion Using Sub-Orbicularis Oculi Fat Lift With Full-thickness Skin Graft

Cicatricial ectropion following facial thermal injury arises from anterior lamellar deficiency and persistent downward traction across the lid-cheek interface. Even with complete scar release and resurfacing, unresolved midface contracture can compromise corneal coverage and graft survival. This report describes a 45-year-old man with 47% total body surface area flame burns, including full-thickness facial involvement, who developed left lower eyelid cicatricial ectropion and exposure keratitis. After excision of the lid cicatrix and extensive facial scar release, residual inferior tension precluded lid apposition to the globe. A subperiosteal sub-orbicularis oculi fat-based midface suspension was therefore performed using drill-hole fixation to the infraorbital rim, reestablishing vertical support and reconstituting the lid-cheek junction. The lower lid was resurfaced with a supraclavicular full-thickness skin graft and stabilized with lateral canthopexy and protective tarsorrhaphy, whereas the adjacent facial defect received a sheet split-thickness graft. Postoperatively, the patient achieved complete graft take, stable eyelid closure, and excellent contour restoration at 3 months. This case highlights the biomechanical benefit of combining sub-orbicularis oculi fat-based midface suspension with lamellar replacement in burn-related ectropion and, in review of the literature, supports this integrated approach as an effective, durable method for restoring lower lid position and corneal protection in complex burn reconstruction.