Personalized comprehensive rehabilitation for preventing complications after lower eyelid plastic surgery - a case series and technical description

Vollständiger Abstract

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Lower eyelid ectropion is a clinically and aesthetically significant complication following blepharoplasty and periocular reconstruction. Although surgical correction is well-established, early postoperative nonsurgical interventions remain limited. This case series describes a structured rehabilitation protocol integrating a custom-fabricated low-temperature thermoplastic eyelid splint with targeted physical therapy for early correction and prevention. We enrolled six patients (eight eyelids) with postoperative lower eyelid ectropion or at high risk for its development in a custom rehabilitation protocol comprising the splint and a structured physical therapy regimen of immediate cold-compress therapy followed by ultrashortwave therapy. Outcomes were evaluated using the validated Moe-Linder ectropion grading scale (EGS), symptom resolution, and patient-reported satisfaction (5-point Likert scale); safety was monitored by recording splint-related adverse events. At 6-month follow-up, among seven therapeutic eyelids, six improved to EGS grade 0, while the prophylactic eyelid maintained grade 0, totaling 7/8 eyelids at grade 0. Of these, five had complete symptom resolution, whereas one showed partial dry eye improvement. One eyelid with EGS grade III ectropion remained grade III. No splint-related complications occurred. Median satisfaction was 5 (range: 4-5), with 7/8 eyelids scoring 5. Early rehabilitation with a custom thermoplastic splint and physical therapy appears effective and safe for postoperative lower eyelid ectropion, particularly in mild to moderate cases, while also serving as a prophylactic measure and offering adjunctive benefits in selected complex cases, though its efficacy appears limited in severe (EGS grade III) ectropion.