Treatment of Severe Lower Eyelid Retraction with Scleral and Free Skin Grafts and Bipedicle Orbicularis Flap

ABSTRACT Surgical repair of lamellar shortening must treat the anterior and posterior shortening, plus the scarring between Mueller's muscle, capsulopalpebral fascia, and periosteum. We describe a repair method in which a full-thickness, free skin graft is used to correct the anterior lamellar defect, and a homologous scleral graft is used to correct the posterior defect. Vascular support for the two free grafts is provided by a bipedicular orbicularis muscle flap.