Composite Advancement Flap (Cutler-Beard Procedure)

  • Richard D. LismanEmail author
  • Christopher I. Zoumalan


The Cutler-Beard procedure is indicated in reconstruction of large defects of the upper eyelid. Typically, defects of more than 60% of the eyelid require repair with this two-stage reconstruction using full-thickness tissue from the lower eyelid. In the first stage, a full-thickness flap from the lower eyelid is advanced posterior to an intact lower eyelid margin. This includes the conjunctiva of the lower fornix, deep tissue of the lower eyelid, and skin. It attains collateral vascularization and lengthens over a period of 3–8 weeks. In the second-stage, the flap is divided at the level of the palpebral fissure, and the lower eyelid is reconstructed. The fornices are moderately foreshortened after this procedure.


Upper eyelid defect Composite advancement flap Cutler-Beard procedure Two-stage advancement flap Bridge flap 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Richard D. Lisman
    • 1
    • 2
    • 3
    Email author
  • Christopher I. Zoumalan
    • 4
  1. 1.Department of Ophthalmology, Plastic SurgeryNew York University School of Medicine, NYU Langone Medical CenterNew YorkUSA
  2. 2.Manhattan Eye Ear HospitalNew YorkUSA
  3. 3.Institute for Reconstructive Plastic SurgeryNew YorkUSA
  4. 4.Department of OphthalmologyKeck School of Medicine of USCBeverly HillsUSA

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