Comparison of the efficacy of hard palate grafts with acellular human dermis grafts in lower eyelid surgery

Background: The Madame Butterfly procedure of lower eyelid reconstruction addresses lower eyelid retraction after blepharoplasty caused by middle lamellar tethering. After scar lysis and subperiosteal midface lift, the surgical procedure uses a lower eyelid spacer graft to prevent further postoperative contraction of the middle and posterior lamellae. Different graft materials have been used, including autogenous hard palate and AlloDerm. Methods: The preoperative and postoperative photographs of consecutive patients who had undergone the Madame Butterfly procedure were analyzed retrospectively. Thirty-five patients undergoing AlloDerm grafting were compared with 25 patients undergoing hard palate grafting. Their lower eyelid heights were digitally measured and analyzed statistically for differences between the two groups. Results: No statistically significant difference was found in the amount of eyelid elevation between the AlloDerm and hard palate groups, although a trend was seen that hard palate grafts resulted in both better elevation (p = 0.121) and a lower failure rate (p = 0.092). Female patients in both groups were found to experience significantly greater eyelid elevation than male patients (p = 0.018). Conclusions: Both AlloDerm and hard palate were found to be successful grafting materials for lower eyelid elevation in patients with postblepharoplasty lower eyelid retraction. Each has advantages and disadvantages, and surgeons should tailor their choices according to each patient.