Objective Outcome Measurement After Upper Blepharoplasty: An Analysis of Different Operative Techniques

Abstract

Background

Upper blepharoplasty is indicated in Asians for double-eyelid fold creation, periorbital rejuvenation, and functional visual field improvement. This article introduces a technical classification for blepharoplasty methods and investigates approaches to evaluate its outcomes.

Methods

Of 535 patients undergoing aesthetic upper blepharoplasty in our institution in 1998–2011, 136 patients who were well followed up were retrospectively reviewed and categorized into four groups according to the techniques employed. Blepharoplasty with skin excision only was indicated for upper eyelid-skin redundancy patients with prominent double eyelids (n = 20). Blepharoplasty with skin excision and nonburied suture fixation was indicated for patients with upper lid-skin redundancy and weak double eyelids (n = 15). Blepharoplasty with skin excision and buried suture fixation was indicated for patients with upper lid-skin redundancy but no double-eyelid folds (n = 46). Finally, blepharoplasty with simultaneous ptosis correction was utilized for patients with senile or subclinical ptosis requesting upper blepharoplasty (n = 55). The mean age was 48.7 years at surgery; the mean follow-up period was 6 months. Digital photographs were used to compare changes in marginal reflex distance 1 (MRD₁), percentage of the area of corneal exposure (%ACE), and brow height.

Results

MRD₁ increased from 1.92 to 2.84 mm in the whole patient group after upper blepharoplasty; it increased the most in blepharoplasty with simultaneous ptosis correction (1.22 mm). %ACE increased from 62.1 to 76.6% (14.5%), whereas brow height decreased from 29.4 to 26.7 mm (9.2%).

Conclusion

Upper blepharoplasty improves palpebral fissure. Numerically measured palpebral fissure changes facilitate operation outcome measurement.

Level of Evidence III

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