tendons provided sufficient stability; thus, no additional support was required. In case of lower eyelid laxity, eyelid tightening should be performed when full-thickness skin grafts are used. 11 In a study from 2008, Codner et al 12 even propagate to routinely include lateral can- thal support to improve esthetic results and provide optimal lower eye- lid contour. Despite the absence of eyelid laxity in our cases, we performed a prophylactic horizontal eyelid tightening using lateral drill-hole canthopexy to counteract potential vertical contracture and to release tension on the tarsorrhaphy sutures. Full-thickness skin grafts have shown to be a valuable method, especially for reconstruction of cicatricial lower eyelid ectropion, leading to notable improvement of periocular surface and reduction of scar contracture. However, transplanted skin shows a tendency for fibrosis formation, thus possibly leading to renewed aggravation of scar contracture. Almost 50% of patients receiving full-thickness skin grafts in the lower eyelid periocular region show residual or recurrent ectropion. 13 Another important consideration is to respect the esthetic facial units and not restrict excision to the extent of the original defect. Replacement of the entire lower eyelid esthetic unit not only prevents vertical scar junctions and thereby consecutive ectropion but also leads to esthetic results that are oftentimes supe- rior to partial subunit reconstruction. 14 Temporary tarsorrhaphy has proven to be an effective method for preventing initial tendency for tissue retraction after laser resurfacing. 15,16 By combining both methods, we achieved excellent defect coverage with excellent skin texture and almost no noticeable tissue contraction, even after 1-year follow-up. Finally, combining total lower eyelid surgery with microfat grafting allowed to restore contour and created a youthful appearance. 17 Although many previous publications mainly focus on individ- ual aspects of lower eyelid reconstruction, we describe a staged re- constructive approach for correction of severely destructed lower eyelid defects with consecutive lower eyelid ectropion. Our hybrid approach of radical resection, skin grafting, and autologous fat trans- fer shows promise in addressing these challenging defects. REFERENCES 1. Narins RS, Beer K. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Plast Reconstr Surg 2006;118:77S–84S 2. Lazzeri D, Agostini T, Figus M, et al. Blindness following cosmetic injections of the face. Plast Reconstr Surg 2012;129:995–1012 3. Rees TD, Ballantyne DL, Seidman I. Eyelid deformities caused by the injection of silicone fluid. Br J Plast Surg 1971;24:125–128 4. Tangsirichaipong A. Blindness after facial contour augmentation with injectable silicone. J Med Assoc Thai 2009;92(suppl 3):S85–S87 5. Hage JJ, Kanhai RC, Oen AL, et al. The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Plast Reconstr Surg 2001;107:734–741 6. Vilde F, Arkwright S, Galliot M, et al. Fatal pneumopathy linked to subcutaneous injections of liquid silicone into soft tissue. Ann Pathol 1983;3:307–312 7. Qian JG, Wang XJ, Wu Y. Severe cicatrical ectropion: repair with a large advancement flap and autologous fascia sling. J Plast Reconstr Aesthet Surg 2006;59:878–881 8. Sugg KB, Cederna PS, Brown DL. The V-Yadvancement flap is equivalent to the Mustarde flap for ectropion prevention in the reconstruction of moderate-size lid-cheek junction defects. Plast Reconstr Surg 2013;131:28e–36e 9. Codner MA, McCord CD, Mejia JD, et al. Upper and lower eyelid reconstruction. Plast Reconstr Surg 2010;126:231e–245e 10. Patipa M. The evaluation and management of lower eyelid retraction following cosmetic surgery. Plast Reconstr Surg 2000;106:438–453 11. Jordan DR, Anderson RL. The lateral tarsal strip revisited. The enhanced tarsal strip. Arch Ophthalmol 1989;107:604–606 12. Codner MA, Wolfli JN, Anzarut A. Primary transcutaneous lower blepharoplasty with routine lateral canthal support: a comprehensive 10-year review. Plast Reconstr Surg 2008;121:241–250 13. Kim HJ, Hayek B, Nasser Q, et al. Viability of full-thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region. Head Neck 2013;35:103–108 14. Lau CK, Huang S, Cormack G. Minimising the risk of ectropion when full thickness skin grafting lower eyelid defects. J Plast Reconstr Aesthet Surg 2008;61:1562–1564 15. Rosenberg GJ. Temporary tarsorrhaphy suture to prevent or treat scleral show and ectropion secondary to laser resurfacing or laser blepharoplasty. Plast Reconstr Surg 2000;106:721–725 16. McInnes AW, Burroughs JR, Anderson RL, et al. Temporary suture tarsorrhaphy. Am J Ophthalmol 2006;142:344–346 17. Trepsat F. Periorbital rejuvenation combining fat grafting and blepharoplasties. Aesthetic Plast Surg 2003;27:243–253 Treatment of Migration and Extrusion of the Gold Weight Eyelid Implant With Fascia Lata Sandwich Graft Technique Hakan Bulam, MD, Onur Öztürk, MD, Erkin Ünlü, MD, Alper Uslu, MD, Sedat Yilanci, MD, Yağmur Bali, MD, Murat Iğde, MD Abstract: Gold weight implantation is generally considered a safe procedure for the treatment of paralytic lagophthalmos. The most frequently seen complications are extrusion, malpositioning, and migration of the implant. To decrease the rate of these complica- tions, several modifications were defined in the composition and the shape of the implant as well as the surgical technique itself. De- spite these precautions, implant revision rates are still as high as 8% to 14%. Nowadays, implant-covering or implant-wrapping proce- dures are becoming more popular to avoid implant-related problems. However, there is limited information in the literature regarding the management of these complications. In this study, we aimed to present the treatment of migration and extrusion of the gold weight implant in a patient with Moebius syndrome by wrapping the implant with autog- enous fascia lata graft. Key Words: Facial paralysis, paralytic lagophthalmos, gold weights, postoperative complications, fascia, fascia lata, Moebius syndrome T here are various techniques used to treat lagophthalmos. The main aim of therapeutic options is the rearrangement of the From the Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey. Received May 9, 2014. Accepted for publication July 14, 2014. Address correspondence and reprint requests to Hakan Bulam, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Numune Training and Research Hospital, Talatpasa Bulvari nr:5 Altindag 06100, Ankara, Turkey; E-mail: hakanbulam@hotmail.com The authors report no conflicts of interest. Copyright © 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000001221 Brief Clinical Studies The Journal of Craniofacial Surgery • Volume 26, Number 1, January 2015 e10 © 2014 Mutaz B. Habal, MD Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.