Eyelid eversion occurred in seven cases. The incidence fell from 12% in the first 50 cases to 2% in the following 50 cases (and to zero in the next 50), thus showing the importance of the learning curve at the onset of this complication . The eyelid eversion always appears early, within 3 weeks (seven cases). Two kinds of eyelid eversion are commonly described: ectropial evolution by excess skin excision and ectropial evolution by orbital septum retraction with a worse prognosis. In the first 50 cases, four patients underwent an upper-eyelid or retroauricular total skin graft and two patients underwent a Khunt-Szymanowsky procedure . In all these patients, the previous history found a lower-eyelid surgery which appears as a risk factor and leads to caution for lower-eyelid skin excision (in these cases, we now approach through an outer upper-eyelid incision).
The lower-eyelid skin graft is well hidden by the make-up and rapidly well integrated within 3 months (Fig. 45.15). We improved our results by introducing a third thread to secure the orbicular grip and by resecting less skin despite the residual excess. Today, we do not resect more than half of the apparent skin excess. Another very important point is to always respect the arcus marginalis during the dissection to avoid any orbital septum retraction .Now we approach though the upper eyelid and lift the cheeks with endotine midface without opening the lower-eyelid muscle or the lower-eyelid skin unless at the end we need a small eyelid skin excision respecting the muscle - zero eversion.
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When over eighty years of age, the poet Bryant said that he had added more than ten years to his life by taking a simple exercise while dressing in the morning. Those who knew Bryant and the facts of his life never doubted the truth of this statement.