The eyelids present unique challenges to the surgeon—the dermis is very thin, with a near absence of subcutaneous fat in some areas. This provides only minimal tissue volume to aid in absorbable suture material breakdown, potentially increasing the chance of suture spitting or suture abscess formation. Moreover, the highly elastic eyelid skin also means that a disfiguring residual pull is possible, so that ectropion—while something to avoid at all costs—is only the most extreme outcome along a spectrum of lid pull abnormalities.

The unique challenges associated with eyelid repair means that some of the standard buried suturing techniques may be less useful in these locations, and the lack of significant tension along most eyelid repairs means that running or transepidermal techniques, which should be used sparingly in many locations to minimize the risk of scar spread, may be appropriate. Medial canthal eyelid repairs should sometimes be avoided altogether, as this area tends to heal well by secondary intention.