Presently, there is no consensus among surgeons when skin flaps or skin-muscle flaps should be utilized. Traditionally, the skin-muscle flap has been used in patients in whom a small amount of excess skin excision (<3 mm) is anticipated. If larger amounts of skin needed to be removed, a skin flap was utilized. Many surgeons, however, employ a skin-muscle flap in all cases while other surgeons prefer skin flaps in all but the young patient with tight skin. In 1977, Spira1 attempted a clinical study to clarify the situation. In a group of 26 patients ranging in age from 35 to 68 years old, he performed a skin-muscle flap on one lower lid and a skin flap on the contralateral lower lid. His operative results were assessed from color transparencies by several plastic surgeons, residents, and students. The photographs were made from 3 to 12 months following surgery. Except for
Adamson PA, Tropper GJ, McGraw BL, Kamer FM. Extended Blepharoplasty. Arch Otolaryngol Head Neck Surg. 1991;117(6):610. doi:10.1001/archotol.1991.01870180046009
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