Restoration of Cilia-Deficient Upper and Lower Eyelids with Reconstructive Eyelash Grafting via Cilia-Bearing Adjacent Tissue Transfer or Full Thickness Skin Grafts Utilizing Ipsilateral or Contralateral Eyelid Tissue Audrey C. Ko, MD1; Tathyana Fernandes Fensterer, MD2; Erin M. Shriver, MD1; Kelly H. Yom, BA3 1 Department of Ophthalmology and Visual Sciences, Division of Oculofacial and Reconstructive Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA 2 Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA 3 Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA

BACKGROUND RESULTS CONCLUSIONS

• Eyelid injury or malignancy can Patient 1: 40-year-old female Patient 2: 57-year-old female with history of left lower • Adjacent tissue transfer and cause loss of eyelashes. Currently with history of multiple basal eyelid basal cell carcinoma status post Mohs excision and grafting of portions of follicle- described eyelash restoration cell carcinomas and squamous reconstruction with Hughes flap and full thickness containing skin from the techniques involve transplanting cell carcinomas of the right postauricular skin graft. The lower eyelid lashes were ipsilateral or contralateral Figure 1. (A) Mohs defect involving the right lateral canthus and lateral aspect absent centrally but present laterally (Figure 5). Eighteen hair-bearing skin grafts or lateral canthus and upper and of the eyelids. Note remaining lashes medially in the upper and lower eyelids. eyelid successfully restores follicular units harvested from the lower eyelids. Repeat Mohs (B) Post-reconstructive photograph demonstrating loss of lashes in the upper months after the original reconstruction, a full thickness eyelashes in non-eyelash and lower lateral 2/3 of the right eyelids. scalp, eyebrows, sideburns, and excision and multiple adjacent tissue transfer containing lashes from the lateral bearing eyelids. leg hair. reconstructions (periosteal flap, left lower eyelid was performed at the defect (Figure 6a). tarsoconjunctival flap, and full At postoperative week 1.5, she maintained viable cilia on • Unlike previously described the graft (Figure 6b). • These methods result in surrogate thickness preauricular area skin methods, these grafts do not eyelashes of inconsistent length, graft) resulted in absence of require chronic trimming to lashes on the lateral upper and variable thickness, and adjust their length, have an lower right eyelid (Figure 1). She misdirected cilia. This can lead to appearance consistent with did not desire a canthoplasty, poor cosmesis and even the surrounding remaining although it was recommended keratopathy. to make the right lateral canthus eyelashes, and maintain a more symmetrical to the left. Six natural orientation. • We describe a novel eyelash Figure 2. Preoperative (A) and intraoperative (B-D) photographs demonstrating months after reconstruction, the site of lash harvest (B), full thickness skin graft containing lash cilia (C), and reconstructive method by she underwent eyelash site of graft and eyelash placement (D). Figure 5. Appearance of left lower eyelid after Mohs excision and reconstruction • Interestingly, whereas adjacent tissue transfer or restoration by adjacent tissue demonstrating mild lower eyelid retraction and absence of lower eyelid lashes centrally. transplanted cilia are typically autologous grafting of full transfer and full thickness skin lost initially after transplant thickness eyelid skin containing graft containing lashes from the and grow back months later, follicular units harvested from medial upper eyelid to the both of our patients retained the ipsilateral or contralateral lateral upper eyelid (Figure 2). the majority of transplanted eyelids. At postoperative month 5, the Figure 3. Five month postoperative photograph after index eyelash hair postoperatively. restoration surgery demonstrating healthy eyelash graft with multiple cilia. patient was noted to have right Figure 6: (A) Intraoperative photograph of the left lower eyelid demonstrating MATERIALS AND METHODS A B cicatricial release and placement of full thickness skin graft containing lashes from the upper eyelid retraction, so she left lateral lower eyelid. (B) One week postoperative photograph of the left lower • If complete restoration of a received a full thickness skin eyelid demonstrating retention of lashes after placement of the graft. A retrospective review of patients full line of lashes is impossible, graft from left upper eyelid and with previous eyelid reconstruction the authors propose a helf free tarsal graft from left upper C D within the past year was conducted. backe approach involving eyelid (Figure 3). At one month restoration of medial and follow up, the new graft had lateral lashes allows for the Two patients had undergone survival of cilia and the patient E Figure 4. One month postoperative support of false lashes. secondary reconstruction of the was pleased with the repair and photograph after second eyelash upper or lower eyelid via autologous restoration surgery demonstrating healed REFERENCE transplant results; she was able graft harvest site, healthy eyelash graft transplantation of periocular tissues to apply false eyelashes to her with survival of cilia (A-B) and successful 1. Klingbeil KD, Fertig R. Eyebrow and Eyelash Hair application of false eyelashes (C-E). Figure 7. Postoperative 3 month photograph of the left lower eyelid. At follow up, containing eyelash cilia. liking (Figure 4). some of the previously present cilia in the grafted area were absent but there was Transplantation: A Systematic Review. J Clin Aesthet new growth of fine cilia noted. Dermatol. 2018;11(6):21-30.