A Method to Reproduce Symmetry in Midfacial Reconstruction: A Report of 19 Cases

Abstract

Background: Reconstruction of facial skin defects remains a clinical challenge. With aging, ptosis of tissue over fixed structures creates an important facial feature known as the tear trough. This study aimed to evaluate the efficacy and aesthetic outcome of a novel surgical technique that reproduced this facial feature while avoiding ectropion during midfacial skin defect repair.

Methods: Nineteen patients with midfacial skin defects received local flap reconstruction combined with an anchoring suture. The flap was designed in a unilateral pedicled V-Y pattern. When the flap was advanced to cover the defect, one or two sutures that connected the dermis of the flap with the infraorbital periosteum were made to reproduce the tear trough line.

Results: Midfacial defects were successfully repaired with the V-Y flap in all 19 patients. No lower eyelid ectropion or conspicuous scars were noted in any of the patients. Further, the tear trough was successfully reconstructed in each patient. Facial symmetry was maintained with static positioning and animation.

Conclusions: The combination of local V-Y flap reconstruction with anchoring sutures to reproduce facial feature lines is an effective technique in midfacial skin defect repair.

Figure 1.

DIAGRAM OF THE FLAP A, Preoperative evaluation of the patient’s facial features. B, Marking the tear trough and lower eyelid-buccal line (dotted line). C, Marking the tear trough and lower eyelid-buccal line after removal of the lesion (dotted line) and design of the unilateral pedicled V-Y pattern local flap (short bar). D, Transferring the flap to cover the defect, marking the tear trough and eyelid-buccal lines on the flap as well as the position for the anchoring suture. E, Penetrating the flap with a 15-gauge needle and marking the anchoring suture points subcutaneously with methylene blue injection. F, Diagram of anchoring suture, taking caution to avoid injury to the maxillary nerve. G, Shaping the flap and wound closure by suture.

Figure 2.

CASE 1 A, Midfacial skin defect immediately following basal cell carcinoma removal. B, Reconstruction of the defect by V-Y flap. C, Illustration of the position of anchoring suture. D, 12-month postoperation anterior view, static. Tear trough and eyelid-buccal junction reproduced. E, 12-month postoperation dynamic anterior view (smiling). Photos courtesy of Hongda Bi, MD, PhD, and Xiaoli Lou, MD, PhD.

Figure 3.

CASE 2 A, Midfacial skin defect immediately following basal cell carcinoma removal. B, Reconstruction of the defect by V-Y flap. C, Illustration of the position of anchoring suture. D, 12-month postoperation anterior view, static. Tear trough and eyelid-buccal junction reproduced. E, 12-month postoperation dynamic anterior view (smiling). Photos courtesy of Hongda Bi, MD, PhD, and Xiaoli Lou, MD, PhD.