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Utilizing techniques from blepharoplasty, midface lifting and facelifting to solve this reconstructive conundrum: a difficult defect involving the lower eyelid, cheek, and a portion of the nasal sidewall. I utilized deep tissue mobilization and SMAS elevation, fat pad rearrangement, and a periosteal anchor to elevate tissue from below with a rotation and Z Plasty to reconstruct. The biggest concern here is malposition of the lower eyelid, called ectropion, where the lid pulls away from the globe, and as you can see at his one-month follow-up his eyelid position was dialed!

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