3-Step Combined Technique for Correction of Involutional Lower Eyelid Ectropion: A Case Series

<b>Background:</b> Involutional lower eyelid ectropion is a common disorder of the elderly population. Several surgical approaches have been described in the literature to address the multifactorial nature of this condition, each targeting different factors contributing to its development. Nevertheless, no single procedure has proven to be superior to the others. This study aims to assess the safety and effectiveness of a new 3-step combined technique in treating involutional ectropion. <b>Methods:</b> The surgical technique consists of a combination of lateral lid-shortening with removal of a base-up triangle (modified Bick procedure), lower eyelid skin release, and transposition of a laterally based myocutaneous flap from the upper eyelid. A retrospective chart review was conducted for all patients treated with this procedure at our institution between 2012 and 2023 was performed. Self-reported patient satisfaction with functional and esthetic outcomes was evaluated three months after surgery. <b>Results:</b> A total of thirty-six patients (forty-five eyelids) were included in the study, with a mean follow-up period of 22 months (range 3-144). Minor surgical revision was performed in one case for early wound dehiscence following premature stitches removal. The overall success rate was 93.2%, with one case of undercorrection and two cases of recurrence recorded at three years postoperatively. No additional complications or recurrences were observed during the follow-up period. <b>Conclusions:</b> The 3-step combined procedure demonstrated high efficacy and safety, offering excellent functional and esthetic outcomes. This approach provides a reliable solution for treating involutional ectropion, making it a valuable addition to the surgical options for this condition.