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

Most often, total and subtotal defects of the eyebrows and eyelids occur as a result of traumatic injuries (scalping), facial burns, radiation therapy, and skin diseases.

Cicatricial deformations (eversion) of the eyelids usually appear as a result of rough scarring of wounds after second- and third-degree burns, accidental trauma, or surgery on the soft tissues of the face.

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

If a defect of the eyebrow, or more precisely its hair, has mainly a cosmetic significance, then a deformation, and especially a defect of the eyelid, can lead to drying out of the conjunctiva and cornea, and therefore to its scarring and blindness.

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

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Treatment of defects and deformations of the eyelids and eyebrows

Elimination of eyebrow defects

Eyebrow defects can be corrected in one of the following ways:

1. free grafting of a strip of skin taken from behind the auricle;
2. eyebrow plastic surgery on a hidden vascular pedicle;
3. open-pedicle flap plastic surgery from the scalp;
4. plastic surgery with a flap on a leg from the other (healthy) eyebrow.

Free skin grafting from behind the auricle

Free skin flap transplantation taken from behind the auricle is advisable if the flap transplanted in the defect area has a good blood supply.

This method is best used immediately after excision of the eyebrow together with the underlying skin (affected, for example, by a capillary hemangioma). After achieving hemostasis (by squeezing small bleeding capillaries with a napkin), a strip of skin of the appropriate shape and size with hair (appropriately directed) is cut out behind the auricle, transferred to the defect area and secured with sutures made of thin nylon or polypropylene. The edges of the wound behind the auricle are separated, brought together and sutured. If the flap takes root, the operation gives a good cosmetic result.

The described method cannot be used for scalp defects, as well as for bald patients. It is also risky to use it for young men, since over time, baldness in them may be accompanied by hair loss on the restored eyebrow.

Eyebrow plastic surgery with a flap on a hidden vascular pedicle

The method is effective, but is possible in the absence of baldness and gross deep cicatricial changes in the temporal and parietal areas. A mandatory condition is the integrity of the trunk and branches of the superficial temporal artery.

It is not used in the absence of hair in the temple area, the impossibility of skin grafting on a hidden vascular pedicle (due to cicatricial deformation of the subcutaneous tissue of the temporal area, destruction of the superficial temporal artery), in the combination of an eyebrow defect with a defect or eversion of the upper eyelid. A mandatory condition for this plastic surgery is the presence of hair on the skin of the frontal and parietal areas.

Eyebrow plastic surgery with a skin flap on a stalk taken from the other eyebrow

Eyebrow plastic surgery using a flap of skin on a stalk taken from another eyebrow is possible provided that the donor eyebrow is wide enough (this usually only happens to men).

The surgical technique: the hair on the healthy eyebrow is shaved off, a line is drawn in the middle of the eyebrow along its entire length with methylene blue; anesthesia is administered on the side of the eyebrow defect, after which the skin (scars) is cut with a horizontal incision, which corresponds in length to the healthy eyebrow.

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

Anesthesia is administered to the healthy eyebrow area and it is cut along the intended line.

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

Trying not to damage the hair follicles, separate the outlined upper "floor" of the eyebrow, turn it 180° and suture it to the edges of the wound in the defect area. Bleeding is stopped by pressing napkins to the wound surfaces on both the donor and recipient sides. Large vessels are ligated with the finest catgut.

The upper incision in the bridge of the nose area should be somewhat longer to ensure a safer bending of the flap leg. It is placed in the receiving bed and stitched with a fishing line using knotted sutures.

The bandage is applied for 2-3 days, and then the operated areas can be treated openly.

The stitches are removed on the 8th-9th day after the operation.

Elimination of eyelid defects and deformations

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

It is best to take skin for eyelid plastic surgery from the anterior-inner surface of the shoulder, since its physiological properties are closest to the skin of the eyelids.

The transplanted skin must be fixed in a hypercorrected position using loop-shaped sutures made of fishing line on the skin of the forehead or cheek (depending on which eyelid is deformed).

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