Aesthetic aspects of reconstructive surgery of the lower lid

Aesthetic repair of the lower eyelid should use palpebral skin and restrict the cutaneous scars to the orbital area. Except in young patients or those having previously undergone a blepharoplasty, it is usually possible to raise a 10- or 12-mm-wide flap from the upper eyelid. The use of such a flap lined with an alar chondromucosal graft is advocated in a one-stage procedure. This graft ensures a good functional result and the stability of the new eyelid because the cartilage is as high in its bulk as the lid. In spite of histologic differences, where the tarsus is not a cartilage and the inner lining of the ala nasi is not actually a mucosa, the alar chondromucosal graft is very much like the tarsoconjunctival complex. When the alar defect is accurately repaired, no deformation of the nose results.