A Hughes flap, also known as a tarso-conjunctival flap, is a flap in the lower eyelid that can be manipulated to repair issues of the lower eyelids. This makes it a useful tool in a physician’s toolkit, as it is adept at aiding in traditionally difficult surgeries. It is also the name of a medical procedure that utilizes this section of tissue.
Replacing elements of the eyelids with other parts of the eyelids makes good surgical sense in many respects, as the tissues between these types of tissues share many similar qualities. This makes for easy physiological integration in a surgical environment.
If you’re interested in learning more about this type of reconstructive eyelid surgery, take a look at this overview of the versatile Hughes flap.
What Is a Hughes Flap?
A Hughes flap is both a section of the eyelid, and a procedure exists that is also known as the Hughes procedure. A Hughes procedure is most commonly used to correct abnormalities of the lower eyelids. Specifically, it is often used to amend one’s appearance after the eyes have been deformed by some type of cancer.
The Hughes procedure is typically performed as a two-step procedure and was developed in 1937 by the medical pioneer Dr. Wendel Hughes. In the Hughes procedure, a physician advances the tarso-conjunctival flap of the upper eyelid to the lower eyelid, often to cover a section of the eye known as the posterior lamella.
In the second stage of this procedure, which typically occurs two weeks after the first stage, the physician separates the flap at the novel lower eyelid margin, which reopens the eyelids and this section of the face.
Why Is This Procedure Performed?
This procedure, along with the other types of eyelid surgery, is designed to restore a sense of aesthetic normality to the eyes after a negative condition has impacted them.
Issues of the eyes tend to draw attention to themselves due to the prominence of these facial features. If something is awry with one’s eyes, then there’s a solid chance that it will spill over into other areas of the patient’s life due to this very prominence.
Beyond the aesthetic elements of this rationale, there are pragmatic concerns about rectifying eye issues. Abnormally formed eyes have the potential to interfere with a patient’s day-to-day life by obscuring one’s vision.
What Occurs During a Hughes Flap Procedure?
Several steps are taken to ensure that the patient has a safe and effective procedure. In general, the following steps can be expected as one goes through the Hughes flap Procedure:
- The patient is sedated using anesthesia
- Sutures are placed in the central upper lid margin of the eye
- The conjunctiva and tarsus are incised, and cut parallel to the upper eyelid margin
- The lower tarsal-conjunctival flap is attached to the lower eyelid tarsus
- Antibiotics are applied to the incisions and surgical sites
Your physician will go over what you can expect from your own procedure, which may come with some level of variability depending on what condition you had in the first place that would necessitate the performance of a Hughes Flap Procedure. During this time, you and
Who Can Benefit from a Hughes Flap Procedure?
Traditionally, this type of procedure is most commonly performed on individuals who have suffered from some type of eyelid skin cancer. Some of the following conditions are considered indications that a Hughes flap procedure could be useful:
- Melanoma
- Squamous cell carcinoma
- Sebaceous cell carcinoma
- Merkel cell carcinoma
- Various eyelid malignancies
- Physical trauma on the eyelids
- Basal cell carcinoma
Many of the above conditions are considered to be serious, life-threatening issues that will involve much more medical care than just cosmetic surgery. However, a Hughes procedure can be an invaluable part of restoring a patient’s appearance and confidence after they have gone through some of the intensive medical procedures required to treat cancer.
Risks of a Hughes Procedure
In general, a Hughes procedure is considered a very functional and aesthetically successful procedure. Most patients who receive this type of treatment will not need to return to the doctor’s office for revision work.
That being said, there are various medical complications that are possible after a Hughes procedure that should be taken into account prior to receiving treatment. Some of the following conditions are considered risks:
- Eyelid retraction
- Ectropion
- Trichiasis
- Lagophthalmos
- Pyogenic granuloma
- Infection
- And more
Your personal situation in terms of risk will be assessed by you and your physician prior to receiving treatment. In general, if you are of good general health then you should be approved for treatment. However, there are some conditions that may prevent you from receiving surgery, especially if your health is weak from the other elements of cancer treatment.
In addition, the skin and tissues of the eyelids are considered very delicate, and must be handled with high amounts of care. Entrusting your procedure to a physician that is less than trustworthy has the potential to be disastrous.
Preparing for Your Hughes Procedure
There are a number of steps that you can take to ensure that your Hughes flap procedure goes as smoothly as possible. Failing to adhere to these precautions has the potential to interfere with your procedure and possibly, your ultimate results. Take heed of the following precautions:
- Quit smoking for several weeks prior to your procedure
- Get plenty of rest in the days leading up to your procedure
- Tell your doctor about any prescription medications you might be taking
- Inform your doctor about any herbal supplements that you might be taking
- Avoid engaging in overly strenuous activities prior to your procedure
Depending on your personal medical profile, your doctor may have additional advice for you to take into account prior to your procedure. You should take into account any advice given, as it has the potential to impact your overall results in a very tangible sense.
Your Pre-Surgical Consultation
Prior to your actual surgical procedure being performed, you’ll engage with your physician in a pre-surgical consultation that assesses your fitness to receive treatment. In addition, this remains the very best time for you to engage in a series of questions with your physician regarding the upcoming medical procedure.
During this time, your medical history and history of surgeries will be gone over in a methodical fashion. This time period serves the purpose of informing you of all of the relevant elements of your procedure, while giving your physician a stronger idea of your general medical profile.
You only stand to benefit from this time period, so you should take advantage of the opportunity to inform your physician of any elements of your medical situation that would influence the overall outcome.
Recovering from a Hughes Procedure
In general, a Hughes procedure is considered a fairly minimally-invasive surgery, as it only involves manipulating the eyelids and the skin surrounding the eyes. Most patients will recover from their own procedure within the span of a few weeks.
That being said, there are certain steps that you can take to attempt to expedite your own recovery process and to minimize your risk of complications. Consider engaging in the following activities to minimize your results:
- Avoid engaging in any overly strenuous activity for several weeks following your procedure
- Avoid excessive levels of sunlight
- Avoid applying eye makeup or other cosmetics to the areas surrounding the eyes
- Continue to engage in smoking cessation for several weeks after your procedure.
- Avoid drinking excessive alcohol in the weeks following your procedure
- Continue to follow any instructions that your physician might have for you in the aftermath of your procedure
Overall, your chance of successfully completing your recovery period in a safe and timely fashion is extremely high, barring any strange event or maladjustment. Your physician will have a set of guidelines for you to engage with following the completion of your initial surgical event.
Choose the Right Surgeon
When choosing your physician for a Hughes flap procedure, you should ensure that you select a board-certified surgeon who is accredited by the ABPS (American Board of Plastic Surgeons). These individuals are certified by a board of their peers as being fit to engage in complex surgeries that require high levels of expertise.
Board-certified surgeons are required to undergo many stringent criteria to determine whether or not they can keep their license to perform complex plastic surgery procedures. This set of criteria ensures that a standard of quality and accountability is maintained, which ultimately benefits both the physicians and the patients.
Do some research into the physician you select for your Hughes Procedure, and always ensure that they are board-certified.
Your Trusted Eyelid Surgeon
If you’re interested in determining whether you can resolve some lower eyelid issues by utilizing the Hughes flap with an eyelid surgeon in Los Angeles, contact our office today to discuss your possibilities.
