Total and Near Total Composite Lower Eyelid Defect Reconstruction with Glabella Flap: An Excellent Option with Limited Donor Site Availability

  • Muhammad Omar Afzal Jinnah Burn and Reconstructive Surgery Center, Lahore, Pakistan
  • Yawar Sajjad Jinnah Burn Center
  • Kamran Khalid Jinnah Burn and Reconstructive Surgery Center, Lahore, Pakistan
  • Moazzam Nazeer Tarar Jinnah Burn and Reconstructive Surgery Center, Lahore, Pakistan
Keywords: Eyelid Reconstruction


Background/Objective: Traumatic loss of the lower eye lid is usually combined with the paucity of adjacent flaps to reconstruct composite defects. We describe the use of Glabellar flaps with composite or cartilage graft to reconstruct total or near total composite lower eyelid defects and its outcome.

Material and Methods: This case series was done from January 2017 to December 2019. Patients of either gender, with unilateral post traumatic partial or full thickness lower eyelid defect of 75% eyelid loss or more and Glabellar flap as only remaining option to reconstruct the anterior lamella were included. Patients with medial, lateral canthi, upper eyelid and injuries to orbital contents were excluded. The outcome was assessed on follow-up by the presence of epiphora, ectropion, lagophthalmos, obstruction of vision, graft infection/ extrusion, lower lid retraction, donor site scarring and the need for flap debulking.

Results: 12 patients were operated for lower eyelid defects. 2 (16.7%) patients had total loss of eyelid, while 10 (83.3%) had near total loss, 7 (58.3%) patients presented with partial thickness loss of the eyelid, while rest presented with full thickness loss. 1 patient (8.3%) presented with epiphora, similarly 1 (8.3%) had obstruction of vision in down gaze and 1 (8.3%) had conjunctivitis. None had any other complaint.

Conclusion: Glabellar flap together with composite or cartilage graft is an excellent option to reconstruct total or near total composite lower eyelid defects.


1. Min K, Lee JH, Kim SC, Choi JW, Oh TS. Quantitative analysis of paralyzed lower eyelid elevation technique: suspension sling versus supporting midcheek lift. Plast Reconstr Surg. 2019; 143 (4): 829e-39e.
2. Lessa S, Sebastiá R, Pontello J. Lateral canthal clefts of the eyelid. Ophthalmic Plast Reconstr Surg. 2019; 35 (5): 491-4.
3. Tinklepaugh A, Husain Z, Libby TJ, Ciocon D. Management of a lower eyelid defect. Dermatol Surg. 2018; 44 (12): 1627-30.
4. Hay D. Reconstruction of both eyelids following traumatic loss. Br J Plast Surg. 1971; 24 (4): 361-4.
5. Achauer BM, Menick FJ. Salvage of seeing eyes after avulsion of upper and lower lids. Plast Reconstr Surg. 1985; 75 (1): 11-6.
6. Scuderi N, Ribuffo D, Chiummariello S. Total and subtotal upper eyelid reconstruction with the nasal chondromucosal flap: a 10-year experience. Plast Reconstr Surg. 2005; 115 (5): 1259-65.
7. Patrinely JR, O'Neal KD, Kersten RC, Soparkar CN. Total upper eyelid reconstruction with mucosalized tarsal graft and overlying bipedicle flap. Arch Ophthalmol. 1999; 117 (12): 1655-61.
8. Acikel C, Celikoz B, Yildiz TF. Y-shape hard palate mucoperiosteal graft and V-Y advancement flap in the reconstruction of a combined defect involving lateral canthus and upper and lower eyelids. Ann Plast Surg. 2004; 52 (1): 97-101.
9. Leibovitch I, Malhotra R, Selva D. Hard palate and free tarsal grafts as posterior lamella substitutes in upper lid surgery. Ophthalmology, 2006; 113 (3): 489-96.
10. Porfiris E, Georgiou P, Harkiolakis G, Popa CV, Sandris P, Sgouras N. Island mucochrondrocutaneous flap for reconstruction of total loss of the lower eyelid. Plast Reconstr Surg. 1997; 100 (1): 104-7.
11. Wlodarkiewicz A, Staniewicz J, Wojszwillo-Geppert E, Roszkiewicz J. Extensive periocular defect reconstruction with local flaps and conchal cartilage graft. Dermatol Surg. 1999; 25 (11): 904-7.
12. Ellis DS, Toth BA, Stewart WB. Temporoparietal fascial flap for orbital and eyelid reconstruction. Plast Reconstr Surg. 1992; 89 (4): 606–12.
13. Koch CA, Archibald DJ, Friedman O. Glabellar flaps in nasal reconstruction. Facial Plast Surg Clin North Am. 2011; 19 (1): 113–22.
14. Lo Torto F, Losco L, Bernardini N, Greco M, Scuderi G, Ribuffo D. Surgical treatment with locoregional flaps for the eyelid: a review. Biomed Res Int. 2017; 2017: 6742537.
15. deSousa J, Leibovitch I, Malhotra R, O’Donnell B, Sullivan T, Selva D. Techniques and outcomes of total upper and lower eyelid reconstruction. Arch Ophthalmol. 2007; 125 (12): 1601–9.
Original Article