Mid-Cheek Lift for Lower Eyelid Defect Reconstruction: Considering Horizontal Location After Excision of Bowen Disease

The lower eyelid is essential for tear film maintenance, globe protection, and facial aesthetics. Reconstruction after cancer excision must restore both function and appearance. We report a 67-year-old man with Bowen disease located 0.5 cm below the left lower eyelid margin and lateral to mid-pupil line. Mohs surgery yielded a 1.5×1.3 cm anterior lamellar defect with intact orbicularis oculi muscle (OOM). Reconstruction was performed via a subciliary incision, dissection between suborbicularis oculi fat (SOOF) and periosteal fat, division of the orbicularis retaining ligament, and preservation of the premaxillary space and zygomaticocutaneous ligament (ZCL). A mid-cheek lift was achieved by suspending SOOF to the arcus marginalis, followed by OOM suspension and skin trimming. At 6 months, the patient showed excellent functional and aesthetic outcomes without ectropion. For anterior lamellar defects situated lateral to the mid-pupil line, satisfactory reconstruction can be achieved with a mid-cheek lift while preserving both the premaxillary space and the ZCL.