Information about the procedure
Restoring the shape and function of the eyelid after tumour removal, trauma or a congenital deformity.
On this page
What it involves
Eyelid reconstruction is a functional operation, not an aesthetic one. The main goal is for the eyelid to close completely and protect the cornea. Appearance comes second, although it also matters.
The most common reason is the removal of a basal cell carcinoma (BCC) — the most common skin cancer, which in about one in ten cases occurs around the eyes.
Reconstruction is planned together with the cancer surgery. First, complete removal of the tumour with clear margins is ensured; only then is it decided how the defect will be reconstructed.
Types and approaches
Direct closure
For small defects, the edges are brought together directly. This gives the best functional and aesthetic result.
Local flaps
Tissue from the neighbouring area is moved to cover the defect while keeping its own blood supply. This provides a good match in colour and thickness.
Skin grafts
For larger defects, skin is taken from the upper eyelid, from behind the ear or from above the collarbone (supraclavicular area). The donor site is chosen to match the colour and thickness of the area being repaired.
Full-thickness eyelid reconstruction
When the defect also involves the inner lining (conjunctiva) and the tarsal plate, all layers are reconstructed. This is the most complex form of the operation.
Who it is suitable for
Suitable for
- A defect after removal of a skin tumour from the eyelid
- Traumatic eyelid injury
- Ectropion or entropion after previous surgery or trauma
- Congenital deformity
- Inability to close the eye completely
Not suitable, or postponed, in cases of
- Incomplete cancer treatment — reconstruction waits until clear margins are confirmed
- Active infection in the area
- Poor general health that rules out surgery
- Uncorrected blood clotting disorders
Preparation
- Histological confirmation of the diagnosis if a tumour is involved
- Ophthalmological assessment of the eye and the lacrimal (tear) system
- Planning the reconstruction together with the extent of excision
- Pre-operative tests appropriate to the extent of surgery
How it is performed
For small defects, the operation is performed under local anaesthesia; extensive reconstructions are done under general anaesthesia or local anaesthesia with sedation. It takes from about an hour to several hours.
Where a tumour is involved, it is first excised with margin control. In some cases, reconstruction is carried out as a second stage, once histology has confirmed clear margins.
Sometimes reconstruction is planned in two stages, several weeks apart — this is not a complication but a planned technique.
Recovery
- The first 48 hoursSwelling and bruising. Ointment is applied to the eye. Vision may be blurred.
- The first weekStitches are usually removed between day 5 and day 10, depending on the area. Daily wound care.
- 2–4 weeksThe swelling subsides. We assess how well the eyelid closes and whether the eye stays adequately moist.
- 1–3 monthsThe tissues soften. Grafts and flaps gradually blend in colour with the surrounding skin.
- 6–12 monthsThe final appearance. In some cases, a further corrective procedure is planned.
Pain and discomfort
Discomfort is usually moderate and controlled with standard painkillers. More bothersome than the pain are temporarily blurred vision, irritation from the ointment and limited eye opening during the first few days.
Risks and complications
Every intervention carries risks. Listing them does not mean they are expected to occur — it allows you to make an informed decision.
- Incomplete eyelid closure, with drying of and damage to the cornea
- Ectropion or entropion — the eyelid margin turning outwards or inwards
- Partial loss of a graft or flap
- Difference in the colour or thickness of the grafted skin
- Infection
- Watering of the eye (epiphora) if the tear ducts are affected
- Need for a second corrective operation — with extensive defects this is the rule rather than the exception
- Recurrence of the tumour if it has not been completely removed
Results and longevity
The goal is a functional eyelid that protects the eye. With extensive defects, the aesthetic result is good but rarely identical to the unaffected side.
Where the defect followed cancer surgery, follow-up continues for years. Basal cell carcinoma rarely spreads (metastasises), but it can recur locally if not completely removed.
A staged plan often gives a better final result than trying to deal with everything at once.