T-Shaped Wedge Resection of the Upper Eyelid: An Alternative to the Pentagonal Wedge.

Purpose: To report the experience with an alternative to the upper eyelid pentagonal wedge resection technique which results in improved cosmesis due to a greater alignment of incisions with relaxed skin tension lines.

Methods: A retrospective review of all patients who underwent the T-shaped wedge resection by the authors from 2009 to 2017. A horizontal eyelid crease incision is made across the upper eyelid skin. A rectangular full-thickness excision extending to the eyelid crease anteriorly, with an additional superior triangle of posterior lamellar excision is performed. The anterior lamella above the eyelid crease is left intact and the eyelid crease incision is used to distribute the relative excess anterior lamellar tissue above the eyelid crease to the horizontally shortened tissue below the crease.

Results: One hundred and four eyelids of 102 patients were included. The mean patient age was 57 and the procedure was performed on 49 right upper eyelids and 55 left upper eyelids. The indications for eyelid resection were benign lesions (n = 57), basal cell carcinoma (n = 27), trichiasis (n = 15), and squamous cell carcinoma (n = 3). Two patients experienced mild postoperative lagophthalmos, which did not require surgical repair. All patients were satisfied with their postoperative appearance. No patients required reoperation related to their procedure.

Conclusion: The T-shaped wedge resection is an alternative to the traditional pentagonal wedge resection of the upper eyelid. This technique uses the natural upper eyelid crease to redistribute the relative excess skin above the defect, rather than extending the excision superior to the eyelid crease which can alter the contour of the crease and potentially create a vertical scar above the crease.