Defects and deformations of eyebrows and eyelids: causes, symptoms, diagnosis, treatment

Most often, total and subtotal defects of eyebrows and eyelids arise due to traumatic injuries (scalping), face burns, radiation therapy, skin diseases.

Cicatricial deformations (eyelids) of the eyelids usually appear as a result of gross scarring of the wounds after burns of II-III degrees, accidental trauma or operation on the soft tissues of the face.

Defects and deformations of the eyelids and eyebrows can also be congenital.

If the defect of the eyebrows, or more precisely of the hairline, has mainly cosmetic significance, then the deformation, and even more so the defect of the eyelid, can lead to the drying of the conjunctiva and the cornea, and hence to scarring and blindness.

Often when eyelids turn out, patients complain of constant lacrimation, pain and stinging in the eye, especially in windy weather and in frost. This entails a decrease in working capacity, so people with such defects sometimes have to change their profession.

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Treatment of defects and deformities of the eyelids and eyebrows

Elimination of eyebrow defects

Elimination of eyebrow defects can be carried out in one of the following ways:

1. free transplantation of a strip of skin taken behind the auricle;
2. plastic eyebrows on a hidden vascular pedicle;
3. plastic flap on the open leg of the scalp;
4. plastic by a flap on a leg from a different (healthy) eyebrow.

Free transplantation of the skin flap taken behind the auricle

Free transplantation of the skin flap taken behind the auricle is advisable if a graft is transplanted in the defect area and a good blood supply is provided.

This method is best used immediately after excision of the eyebrow along with the underlying skin (affected, for example, by capillary hemangioma). After reaching the hemostasis (by squeezing the small bleeding capillaries with a napkin), a strip of skin of appropriate shape and size with a hair covering (correspondingly directed) is cut behind the ear shell, transferred to the defect area and sealed with thin nylon or polypropylene. The edges of the wound behind the auricle are separated, brought together and stitched. In the case of engraftment of the flap, the operation gives a good cosmetic result.

The described method can not be used with scalp defects of the scalp, as well as in bald patients. It is also risky to use it in young men, since in the course of time baldness in them can be accompanied by loss of hair on the restored eyebrow.

Plastic eyebrow flap on a hidden vascular pedicle

The method is effective, but it is possible in the absence of baldness and gross deep cicatricial changes in the temporal and parietal areas. An obligatory condition is the integrity of the trunk and branchings of the superficial temporal artery.

Do not use it in the absence of hair in the field of the temple, the impossibility of a skin transplantation on a hidden vascular pedicle (due to cicatricial deformation of the subcutaneous tissue of the temporal region, destruction of the superficial temporal artery), with a combination of a defect of the eyebrow with a defect or a reversal of the upper eyelid. A prerequisite for this plastic is the presence of hair on the skin of the frontal and parietal areas.

Eyebrow plastic surgery on the leg, taken from the other eyebrow

The plasty of the eyebrow with a flap of skin on the foot taken from the other eyebrow is possible provided that the donor's eyebrow is wide enough (this usually happens only in men).

Procedure: shave the scalp on a healthy eyebrow, methylene blue, draw a line in the middle of the eyebrow along its entire length; make an anesthesia on the side of the defect of the eyebrow, then dissect the skin (scars) by a horizontal incision, which along the length corresponds to a healthy eyebrow.

The edges of the wound are slightly separated and spread apart with gauze balls, creating a sufficient width for the skin flap transplanted here from another (healthy) eyebrow.

Anesthesia is made in the area of a healthy eyebrow and dissect it along the intended line.

The inner end of the incision is brought to the middle of the bridge of the nose. Above this incision make a second - along the upper edge of the eyebrow, and its outer end is extended to the outer end of the first incision.

Trying not to damage the hair bulbs, they cut off the upper "floor" of the eye outlined in this way, rotate it 180 ° and sutured to the edges of the wound in the area of the defect. By pressing napkins to the wound surfaces both on the donor and the recipient side, bleeding is stopped. Large vessels are ligated with the finest catgut.

The upper incision in the region of the bridge of the nose should be somewhat longer to ensure a more secure inflection of the flap leg. He is laid in a receptive box and hemmed with filleted sutures.

The bandage is applied for 2-3 days, and then it is possible to conduct the operated sections by the open method.

Sutures are removed on the 8th-9th day after surgery.

Elimination of defects and deformations of the eyelids

Treatment is performed, mainly by free transplantation of split skin grafts. As experience shows, the true size of the skin defect of the century can be established only on the operating table.

It is best to borrow the skin for the plasticity of the eyelid from the anterior-inner surface of the shoulder, since it has the closest physiological properties to the skin of the eyelids.

Fix the transplanted skin in the position of hypercorrection with loop-like sutures from the line behind the skin of the forehead or cheek (depending on which eyelid is deformed).

Blepharoplasty with Filatov's stem is performed only in those cases when there is not only an isolated defect or deformation of the skin of the eyelid, but also a defect of adjacent soft tissues of the face.