Management of Persistent Post-Blepharoplasty Lagophthalmos Caused by Anterior Lamellar Deficiency: A Case Report and Review of Reconstructive Principles

Lagophthalmos is an uncommon but potentially vision-threatening complication of upper blepharoplasty. While mild postoperative lagophthalmos may improve with conservative management, persistent cases associated with anterior lamellar deficiency and cicatricial contracture often require surgical correction. We present a case of chronic post-blepharoplasty lagophthalmos that developed following early wound dehiscence and secondary intention healing, resulting in progressive anterior lamellar shortening and impaired eyelid closure. A 68-year-old woman presented with a 2-year history of persistent left-sided lagophthalmos following bilateral upper blepharoplasty and facelift. The postoperative course had been complicated by bilateral upper eyelid wound dehiscence within the first postoperative week, followed by scar contracture and progressive eyelid shortening. The patient reported chronic ocular dryness, dependence on lubricating drops, and nightly eyelid taping to achieve corneal protection. Examination demonstrated a 3- to 4-mm central lagophthalmos defect, elevated upper eyelid scarring, and significant anterior lamellar deficiency without facial nerve dysfunction or exposure keratopathy. Following complete release of the contracted upper eyelid tissues, a larger-than-anticipated anterior lamellar defect measuring 20 × 6 mm was identified. Reconstruction was performed using a postauricular full-thickness skin graft with temporary tarsorrhaphy and bolster fixation. At 4-month follow-up, the patient demonstrated complete graft survival, resolution of lagophthalmos, elimination of nighttime taping, reduced lubricant requirements, and high patient satisfaction. Persistent lagophthalmos following blepharoplasty may result from progressive cicatricial shortening after postoperative wound dehiscence and secondary healing. Complete release of contracted tissue followed by tension-free restoration of anterior lamellar length with full-thickness skin grafting can reliably restore eyelid closure and improve both functional and aesthetic outcomes. Accurate graft sizing should be performed only after complete scar release, as preoperative estimation may underestimate the true extent of tissue deficiency.