This patient had a large left lower lid skin cancer (basal cell carcinoma). Mohs surgery by a dermatologist was performed to remove the skin cancer (which is located between the black border as shown above). The patient had over 33% loss of his lower lid from the Mohs surgery. Dr. Zoumalan performed eyelid reconstructive surgery to help repair the defect. A skin/muscle advancement flap was used to repair the defect. The post operative photos were taken 3 months after surgery. Notice the natural looking result and normal lid position and contour.
Preoperative Diagnosis: Left lower lid basal cell carcinoma (skin cancer)
Procedure performed: Excision of left lower lid skin cancer with eyelid reconstruction using a skin/muscle advancement flap.
Surgeon: Christopher Zoumalan, MD. Oculoplastic Surgeon.
Location: Beverly Hills, California
This patient had a biopsy proven right medial canthal (eyelid) basal cell skin cancer. It was removed by a Mohs trained dermatologist. The skin cancer also involved her tear duct system. Dr. Zoumalan was able to reconstruct her defect using local skin flaps. Her tear duct was also reconstructed with the use of silicone tubes as stents. Her post operative photograph was taken six months after surgery and note the natural appearing result with very well healed incisions. Her tear duct system remains patent and functioning normally.
Preoperative Diagnosis: Right eyelid (medial canthal) basal cell skin cancer involving the tear duct system.
Procedure performed: Eyelid reconstruction using skin flaps and tear duct reconstruction
This patient was diagnosed with an atypical pigmented lesion (pre-melanoma) in her right lower lid. Treatment required complete excision with several millimeters of free margin tissue. She underwent excision of the lesion and eyelid reconstruction was then performed. A local skin muscle flap was used to fill in the defect. The procedure is also referred to as a Tenzelmyocutaneousreconstructive flap.
Preoperative Diagnosis: Right lower lid atypical pigmented lesion (pre-melanoma)
Procedure performed: Excision of lesion with eyelid reconstruction (skin muscle rotational flap, also referred to as a Tenzelmyocutaneous flap)
1) This patient had a recurrent squamous cell carcinoma of the left eyelid. It involved the medial (closest to the nose) portion of his upper and lower eyelid.
2) The surgical plan was to have the patient undergo a Mohs excision of the tumor by a Mohs-trained Dermatologist. The black outline depicts the area of resection that was necessary in order to clear the tumor and have clear (tumor-free) margins.
3) This photograph (top right) was taken 6 monts after surgical repair. The patient had siginficant loss of tissue in the medial aspect of his eyelids and had to undergo two local skin and muscle advancement flaps to mobilize local tissue to close the defect. He also lost his tear ducts during the removal of the tumor but has since remained tumor free and very happy with the cosmetic results.
If it is a small defect, often local tissue can be rearranged or brought together to repair the eyelid. If it is a large defect like seen in the photo below, up to 80 percent of the lower lid is mssing along with the tear duct system. In such instances, tissue from the upper lid is often needed to repair the defect through a procedure called a Hughes flap (aka tarsoconjunctival flap) named after one of the pioneers in Oculoplastic Surgery, Dr. Wendell Hughes. Tissue is taken from the upper lid as seen in this following photo and transfered in the lower lid. Unfortunately, the eyelid is sewn shut for at least one month until the flap takes place. A second surgery is then performed to “take down” the flap and allow for the eyelid to be reconstructed to a normal-appearing eyelid.
1) This photo above shows a squamous cell carcinoma of the right lower lid that after its complete excision, was left with a defect that spanned the markings drawn on the photo. The resection also involved her lower lid tear duct system. This particular patient did very well after the first stage and went home the same day with little discomfort.
2) The patient underwent a a second stage surgery which was performed several weeks later to detach the flap and reconstruct both upper and lower lids to position them as close to their natural, presurgcial position as possible. She is cancer free, can see from that eye now (top right), and has a good position and contour of her lower lid. Note that she has lost her eyelashes in the lower lid which occured once the tumor was removed in the primary excision.
1) This patient presented with a squamous cell carcinoma of his right upper lid (Top left photo). Marking pen was drawn around the lesion prior to it being excised.
2) Once the biopsy was proven to be a malignancy, MOHS surgery was then performed by a fellowship-trained MOHS surgeon to completely remove the lesion and to provide free margins of healthy tissue. (Middle photo).
3) Next, the defect was repaired by Dr. Zoumalan using local tissue advancement flaps once the MOHS surgeon had completed the resection. This picture was taken a little over three weeks after surgery.
This patient had a large, nodular basal cell carcinoma of her right lower lid. It was excised completely and there was an approximate 25-30% defect in the lower lid. The black mark denotes the amount of eyelid that was resected in order to remove the skin cancer.
She underwent eyelid reconstruction in the operating room using local advancement of tissue. She did well and this photo (top right) was taken 6 weeks after surgery. Note the lid symmetry and lack of abnormal scar formation.
Preoperative Diagnosis: Right lower lid basal cell carcinoma that was biopsied in the office.
Intraoperative picture shows up to 70 percent of the right lower lid resected. Eyelid reconstruction will need to be performed to allow a normal, functioning eyelid. The patient underwent a myocutaneous advancement flap (Tenzel flap). The outline of the flap is designated by the purple mark on the corner of the lateral lid.
Post surgery photo was taken 4 months after right lower lid reconstruction after the patient underwent a myocutaneous advancement flap (Tenzel flap).
Preoperative Diagnosis: Right lower lid basal cell carcinoma
Procedure performed: Right lower lid excision of basal cell carcinoma and reconstruction using a myocutaneous advancement flap (Tenzel flap).
This patient was seen by her Dermatologist specialized in Mohs surgery and underwent a removal of a large basal cell carcinoma that involved her eyelid, medial canthus, and lower cheek.
She underwent reconstruction of her eyelid, medial canthal, and lower cheek in the operating room using local advancement flaps. She is four months out in this photograph above and shows a great result with little scarring. Some patients tend to scar more than others and we attempt to optimize our patients as best as possible before, during and after surgery to help prevent as much scarring as possible. The surgery was done in conjunction with Dr. Richard Zoumalan, a facial plastic surgeon who works alongside Dr. Christopher Zoumalan on complicated eyelid and facial plastic procedures to produce the best desired outcome.
Preoperative Diagnosis: Left eyelid, medial canthal, and left cheek basal cell carcinoma.
Procedure performed: Left eyelid, medial canthal, and left cheek reconstruction using myocutaneous advancement flaps.
Preoperative Diagnosis: Left lower lid basal cell carcinoma that was biopsied in the office.
Intraoperative picture shows up to 50 percent of the left lower lid resected (middle photo). Eyelid reconstruction will need to be performed to allow a normal, functioning eyelid. The patient underwent a myocutaneous advancement flap (Tenzel flap).
Post surgery (Top right) photo was taken 5 months after left lower lid reconstruction using a myocutaneous advancement flap (Tenzel flap).
Preoperative Diagnosis: Left lower lid basal cell carcinoma
Procedure performed: Left lower lid excision of basal cell carcinoma and reconstruction using a myocutaneous advancement flap (Tenzel flap).
Preoperative Diagnosis: Left upper lid squamous cell carcinoma that was biopsied in the office. Black lines demarcate the extent of the tumor and what was actually removed by his dermatologist using Mohs surgery.
Procedure performed: Left upper lid excision of squamous cell carcinoma through Mohs surgery and reconstruction using a myocutaneous advancement flap (Tenzel flap).
Preoperative Diagnosis: Right lower lid atypical pigmented lesion. Although it wasn’t a melanoma, there was still concern for it transforming into one or perhaps have microscopic cells of melanoma. As a result, she underwent excision of the lesion with free margins of normal tissue. (Middle photo)
Procedure performed: Excision of right lower lid lesion and reconstruction using a large cheek skin flap. Photo top right shows results 4 months after surgery.
This 75 year old female had a slowly growing left lower lid tumor. Biopsy confirmed a basal cell carcinoma. Dr. Zoumalan removed the tumor in the operating room and the margins were free of tumor. Eyelid reconstruction was preformed to close the defect which was approximately 40% in size. A local transfer of her lid and cheek tissue was used to fill in the defect. She has healed well and has excellent function of her lid with no ocular discomfort. Most importantly, the cancer has been excised. This photograph was taken four months after surgery.
Preoperative Diagnosis: Left lower lid basal cell carcinoma.
Procedure performed: Excision of left lower lid basal cell carcinoma, eyelid reconstruction using a Tenzelmyocutaneous advancement flap.