Reconstruction of Full-Thickness Lower Eyelid Defects After BCC Excision Using a Modified Hughes Procedure

Background: Basal cell carcinoma (BCC) is the most common malignant tumor of the eyelid. These cancers often necessitate eyelid reconstruction in ophthalmic plastic surgery, which poses significant challenges. This study describes the use of a tarsoconjunctival flap from the orbicularis oculi muscle of the upper eyelid for reconstructing full-thickness lower eyelid defects following BCC resection. Methods: Four consecutive patients with full-thickness lower eyelid BCC underwent radical resection with 3-mm margins, followed by reconstruction using a tarsoconjunctival flap from the upper eyelid. Digital photographs were taken at baseline and at 1, 3, and 6 months post-surgery to evaluate clinical outcomes. Histological examination confirmed complete tumor excision in all cases. Results: The modified Hughes procedure resulted in a high rate of functional and aesthetic success, with no recurrences observed over an average follow-up of 12 months. None of the patients experienced temporary forced eyelid closure, and both aesthetic and functional results were satisfactory. Conclusions: The tarsoconjunctival flap from the upper eyelid is an effective method for reconstructing extensive full-thickness lower eyelid defects, providing excellent functional and aesthetic outcomes.