Fig. 2

Photographs of a modified Hughes procedure. a A patient with a full-thickness lower eyelid defect with histopathologically confirmed tumor-free boundaries after BCC excision. b Measuring the defect size and the subsequently required Hughes flap width. c Incision in an inverted U shaped manner through conjunctiva and the full thickness of the tarsus. d Dissection of all fibromuscular levator aponeurosis attachments from the anterior tarsal surface e, f Edges of the Hughes flap are sutured to the remnants of the medial and lateral tarsus of the lower eyelid. g Preparation of an inferiorly based skin-muscle advancement flap. h Fixation of the advancement flap with absorbable sutures to the lateral wound margins and posteriorly to the Hughes flap. i The left eye post-surgically (before the pedicle division)