Eyelid basal cell skin cancer and reconstruction Plastic Surgery by Michael Bermant, MD Board Certified Plastic Surgeon

Eyelid reconstruction after basal cell carcinoma was done with a Mustarde cheek rotational flap. The flap lining and support came from the nasal septal cartilage and mucosa.

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Facelift / Neck lift (rhytidectomy)

Ptosis of the eyelid (drooping of the upper eyelid)

Simple congenital
Acquired Myogenic (muscle related)
Ptosis associated with Blepharophimosis (congenital eyelid deformity)
Ptosis associated with paralyzed eyebrow muscle

Blepharoplasty (Cosmetic surgery of the eyes)

Ectropion (Drooping of the lower eyelid)

Recurrent ectropion after multiple cancer resections and then skin cancer excision with Mohs' chemosurgery and full thickness skin grafts.

Reconstruction of the lower eyelid

Mustarde Reconstruction

Facelift surgery (rhytidectomy)

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Eyelid Reconstruction

Tumor Before Surgery

86 year old male biopsy proven cancer lower eyelid.

tearing started about 2 weeks ago
lower punctum (tear drain hole) pulled from eye surface

Close up of tumor shows that it is very close to the punctum (the hole that the tears drain from the eye). Basal cell carcinoma tends to grow much more rapidly when mucosa is involved.

Tumor Excised Modified Mohs' Technique

Defect after first specimen

The metal probe is in the punctum and into the caniculus- the drainage system for the eye's tears.

After second specimen, the orbital fat is seen in the center of the wound.

Three separate excisions were needed until all margins were clear of tumor. This was a sclerosing basal cell carcinoma. The wire is in the tear drainage system (punctum and caniculus). Pathology cleared the margins and this did not need to be excised.

Reconstruction - Graft from nose

This is a 17 mm piece of cartilage and mucosa from the nasal septum (wall between the nasal passages. It will be placed under the cheek flap to add support to the eyelid. Normal eyelid has cartilage support (tarsus) and mucosal lining to protect the eye.

The black protector behind the eyelids protects the eye during surgery.

Mustarde Cheek Reconstruction

Tape keeps suture away from eye

After surgery

Reconstruction by sliding remaining eyelid towards nose.
Cheek skin then slid to provide remaining eyelid outer skin
Cartilage and mucosa from nose add support for the cheek flap.

The forehead flap is a second area of reconstruction for another cancer (squamous cell carcinoma).

See how this reconstruction improves over time.

After surgery results
After surgery results part II with movie

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