Measurement of Change in Lower Eyelid Position in Patients Undergoing Transcutaneous Skin-Muscle Flap Lower Eyelid Blepharoplasty

Abstract

IMPORTANCETranscutaneous lower eyelid blepharoplasty is a commonly performed procedure with a postoperative risk of eyelid malposition.OBJECTIVE To quantify the change in lower eyelid position after transcutaneous lower eyelid blepharoplasty. DESIGN, SETTING, AND PARTICIPANTSThis retrospective medical record review describes patients who underwent transcutaneous blepharoplasty at a private facial plastic surgery practice. Patients with less than 3 months of follow-up, a history of periocular trauma, and concurrent midface lift were excluded.INTERVENTIONS Bilateral skin-muscle flap lower eyelid blepharoplasties with possible tarsorrhaphy, canthopexy, or canthoplasty as indicated.MAIN OUTCOMES AND MEASURES Lower eyelid position determined by measurement of preoperative and postoperative pupil to eyelid and lateral limbus to eyelid distances.RESULTS Data from 100 consecutive patients (mean age, 56.7 years; 92 female [92.0%]) undergoing bilateral skin-muscle flap lower eyelid blepharoplasty were analyzed. The mean increase in distance was 0.33 mm (95% CI, 0.24-0.42 mm) from the pupil to the lower eyelid margin and 0.32 mm (95% CI, 0.23-0.41 mm) from the lateral limbus to the lower eyelid margin at final follow-up. For both measurements, patients undergoing concurrent canthopexy had a significantly greater change in eyelid position (P < .001). Men had a greater change in the distance of pupil to lower eyelid compared with women (0.76 mm; 95% CI, 0.44-1.08 mm, vs 0.30 mm; 95% CI, 0.20-0.39 mm, respectively; P = .008) at final follow-up. Two patients required revision procedures secondary to eyelid malposition, and 25 patients had new onset of dry eye symptoms.CONCLUSIONS AND RELEVANCE Transcutaneous skin-muscle lower eyelid blepharoplasty with selective performance of canthoplasty or canthopexy causes a small, predictable eyelid position change in this population with a low rate of revision procedures.LEVEL OF EVIDENCE 3.

Changes in Tear Meniscus Height Following Lower Blepharoplasty as Measured by Optical Coherence Tomography

“…Taban et al [ 13 ] reported that the change in lower eyelid position was not statistically significant after a transconjunctival lower blepharoplasty with or without a skin pinch. Sultan et al [ 14 ] reported that transcutaneous skin-muscle flap lower eyelid surgery increased the distance between the pupil and lower eyelid margin. Segal et al [ 15 ] reported that transconjunctival blepharoplasty with or without skin resurfacing did not induce lid retraction but elevated the lower lid in the majority of patients.…”

Direct Excision of the Lower Eyelid: A Safe and Effective Method for Treating Dermatochalasis and Pigmentation

“…[10][11][12] In a retrospective review of 100 patients, Sultan et al found that transcutaneous skin-muscle lower eyelid blepharoplasty produced a small, predictable eyelid position change of 0.33 mm from the pupil to the lower eyelid margin and 0.32 mm from the lateral limbus to the lower eyelid margin. 13 While they reported a low rate of revision procedures, we have anecdotally found that many patients are dissatisfied with even this small amount of eyelid change.…”

Managing the Lower Eyelid Complex in the Thick-Skinned Patient

“…The distraction test evaluates whether the lower lid can be pulled > 6 mm from the globe. 11 If this is the case, lid support is poor. Poor lid support can lead to several issues postoperatively if not addressed intraoperatively including ectropion, dry eye, exposure keratitis, epiphora, etc.…”