Free Skin Graft

Patients with recurrent (refractory) palpebral ectropion or recurrence after multiple ectropion corrective surgeries are found with distinct skin defects (prior excess resection of the eyelid skin), scar fibrosis, or severe aging laxity at the lower eyelid, causing the tension to be unable to support the eyelid; they should therefore consider undergoing lower eyelid scar release and full thickness skin grafting (FTSG). This surgery involves releasing or partially excising the scar near the previous eyelid wound to restore the normal elasticity of the contracted lower eyelids and then harvesting some thick skin from the patient’s retroauricular area, sideburns, and hairline or even contralateral eyelid and directly emplacing the skin graft to the defects formed by the affected lower eyelid scar resection and skin shortage. However, because the appearance after skin grafting leads to an esthetic difference (such as the stitching line between the new and old skin or color difference), despite this not being a complex surgery, it is mainly used for senior patients with skin defects resulting in lower eyelid trauma or severe extropion.

Surgical conditions


  • Type of anesthesia: IV sedation + local anesthesia
  • Surgical incision: The original lower eyelid incision
    Retroauricular, hairline, or upper eyelid incision (for harvesting the skin)
  • Recovery: 7 days
  • Removal of stitches: 7–10 days

General instructions

No food and water on the day of surgery

  • Avoid smoking for 1 week preoperatively.
  • Fast from food and water for 6 h on the day of operation.
  • Apply cosmetic gel to the lower eyelid for 2 weeks postoperatively to stabilize the surgical results.
  • Avoid smoking, alcohol, and irritating foods for 1 month postoperatively.
  • Avoid staying up late and violent squeezing and the rubbing the eyelids for 3 months postoperatively.

Ideal candidates

  • Senior patientspatients with severe palpebral ectropion
  • Patients with palpebral ectropion due to distinct shortage of lower eyelid skin
  • Those with palpebral ectropion recurrence after several palpebral corrections
  • Those with severe palpebral ectropion and combined red flesh exposure or epiphora

Potential complications

  • Scar hyperplasia
  • Skin graft necrosis
  • Scar contracture
  • Color difference
  • Ectropion recurrence

Surgical advantages

  1. The surgery is simple and has almost no risks.

  2. It directly improves the fundamental problem of skin defects, so the recurrence rate is extremely low.

Surgical drawbacks

  1. The site of skin grafting at the lower eyelid is not esthetical due to a patch scar or color difference.

  2. An additional wound is made at the site for harvesting the skin.

  3. There may be necrosis or failure of the grafted skin.

  4. The grafted skin may contract, thus affecting the correction results.