Superiorly hinged blepharoplasty flap for reconstruction of medial upper eyelid defects following excision of xanthelasma palpebrum

This paper documents an interventional case series which describes a novel technique for reconstructing large medial upper eyelid skin defects following excision of xanthelasma palpebrum. All visible upper eyelid xanthelasma is excised and a superiorly hinged blepharoplasty skin flap is created with a classic skin crease and lateral blepharoplasty incision, the latter acting as an effective 'back-cut' to allow medial advancement of the flap into the defect. Excess triangles of skin are excised and the flap is sutured without tension into the defect in a conventional manner. The patients selected were patients with medial upper eyelid skin defects not amenable to direct closure following surgical excision of xanthelasma. The main outcome measures were the upper eyelid aesthetic and functional outcome, postoperative complications and need for revisionary surgery. In our study seven patients with bilateral medial upper eyelid xanthelasma excised and reconstructed with this technique were identified. Good aesthetic outcome and high patient satisfaction without functional compromise was achieved in all patients at the last follow-up visit. Patient age ranged from 30–52 years old. Follow up ranged from 8 to 18 months. In conclusion, the superiorly hinged blepharoplasty skin flap is a novel and simple technique for the reconstruction of skin defects that are not amenable to direct closure following xanthelasma excision. It avoids the complications of skin grafting and non-surgical ablative methods, particularly in dark-skinned patients.