Recent Advances in Eyelid Reconstruction: A Systematic Review and Meta-Analysis of Surgical Techniques, Functional Outcomes and Aesthetic Results from January 2000 to June 2026
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Eyelid reconstruction requires restoration of ocular protection, eyelid stability, mobility and facial symmetry while minimizing postoperative malposition and donor-site morbidity. Although numerous reconstructive techniques are available, comparative evidence remains limited and outcomes vary according to defect characteristics and surgical indication. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 and prospectively registered in PROSPERO (CRD420261468124). Studies published from January 2000 through June 2026 evaluating surgical reconstruction of structural eyelid defects were eligible. Functional, aesthetic and safety outcomes were synthesized using random-effects models when studies were sufficiently comparable. Risk of bias was assessed using design-appropriate instruments and certainty of evidence was evaluated using GRADE. Technique-specific single-arm estimates were interpreted descriptively because of potential confounding by indication. Results: Thirty-two studies comprising 2,184 participants and 2,326 reconstructed eyelids or defects contributed to the quantitative synthesis. The pooled functional-success proportion was 89.4% (95% CI, 86.5%-91.8%; I² = 68.2%), while pooled aesthetic success was 86.2% (95% CI, 82.8%-89.1%; I² = 72.4%). The pooled postoperative complication rate was 17.9% (95% CI, 14.6%-21.7%; I² = 74.1%), eyelid malposition occurred in 12.1% (95% CI, 9.7%-15.0%), flap or graft failure in 2.7% (95% CI, 1.7%-4.2%) and revision surgery in 7.8% (95% CI, 6.0%-10.0%). Crude outcomes varied across reconstructive techniques; however, these differences were not interpreted as evidence of comparative superiority because procedure selection was strongly influenced by defect size, location, lamellar involvement, etiology and reconstructive complexity. Certainty of evidence ranged from moderate to very low and was limited by predominantly retrospective study designs, heterogeneous outcome definitions, substantial between-study heterogeneity and imprecision. Conclusion: Contemporary eyelid reconstruction is associated with generally favorable functional and aesthetic outcomes and relatively low rates of tissue failure and revision. Nevertheless, the available evidence does not support universally superior reconstructive technique. Procedure selection should remain individualized according to defect anatomy, lamellar involvement, canthal stability, tissue quality, ocular-surface requirements and patient priorities. Greater confidence in comparative effectiveness will require prospective multicenter studies using standardized defect classifications, validated outcome measures, clearly defined analytical units and consistent reporting of complications and patient-reported outcomes.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7204030652