Innovations in eyelid surgery. New concepts in the management of patients

A new technique of full-thickness skin graft fixation utilizing central and paracentral sutures between the graft and the depths of the recipient bed is described. The intrinsic fixation provided by these sutures eliminates the potential dead space, and the shearing strains that jeopardize a successful take. The validity of Hering's law in levator surgery and other clinical implications of reciprocal innervation of the levator muscles of the two upper eyelids are demonstrated. The traditional teaching of oculoplastic surgery considers it obligatory that defects created by margin-including full-thickness excisions of the lower eyelids be surgically reconstructed immediately, but it is shown that spontaneous reformation after such excisions gives satisfactory results.