J Korean Ophthalmol Soc.  2015 Dec;56(12):1831-1839. 10.3341/jkos.2015.56.12.1831.

Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

Affiliations
  • 1Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. eye@cha.ac.kr

Abstract

PURPOSE
Various forms and degrees of morphological changes in the lower eyelid are presented in this study. A comprehensive, individualized clinical approach based on sound anatomical principles and lower lid stability is needed. We evaluated morphological outcomes of lower blepharoplasty by measuring lower eyelid position.
METHODS
One hundred sixty-eight eyes underwent lower blepharoplasty between August 2009 and August 2014. The mean patient age was 62.1 +/- 13 years and mean follow-up period was 6.0 +/- 10.2 months. Lower eyelid position of 84 consecutive primary lower blepharoplasty patients (52 females and 32 males) was analyzed using digital images and measured with standardized data points using the Image J Program.
RESULTS
Of the 168 individualized lower eyelid blepharoplasties analyzed, margin reflex distance 2 (MRD2) decreased from 5.4 +/- 1.1 mm to 4.9 +/- 0.8 mm (p = 0.005) and marginal nose distance (MND) increased from 59.2 +/- 18.3 mm to 61.9 +/- 17.6 mm (p < 0.001). Complications after lower blepharoplasty were not observed.
CONCLUSIONS
The position of the lower eyelid improved after individualized lower blepharoplasty that addressed all the anatomical lower eyelid findings was performed.

Keyword

Eyelid position; Lower blepharoplasty

MeSH Terms

Blepharoplasty*
Eyelids*
Female
Follow-Up Studies
Humans
Nose
Reflex

Figure

  • Figure 1. Examples of patients before and after individualized lower blepharoplasty. Case 1, 54- year-old female underwent skin ex-cision, orbicularis tightening and fat removal. (A) Before surgery, (B) after surgery. Case 2, 78-year-old male underwent orbicularis muscle tightening and lateral canthal suspension. (C) Before surgery, (D) after surgery. Case 3, 59-year-old male underwent skin excision and minimal fat removal. (E) Before surgery, (F) after surgery. Case 4, 58-year-old male underwent fat transposition. (G) Before surgery, (H) after surgery.

  • Figure 2. Schematic drawing of surgery for correction of right lower eyelid laxity. Blue line indicates lateral canthopexy, red line indicates lateral canthal suspension and green line in-dicates orbicularis flap suspension (Bold line: superficial lay-er; dotted line: deep layer).

  • Figure 3. Measurement of the clinical parameters for the low-er lid position. MRD1, IPF, MRD2 and MND were analyzed with the Image J program (NIH, Bethesda, MD, USA). IPF = interpalpebral fissure; MND = marginal nose distance; MRD1 = marginal reflex distance 1; MRD2 = marginal reflex distance 2.

  • Figure 4. Periorbital parameters after lower blepharoplasty us-ing individualized technique. Pre = pre-operation; Post = post-operation; MRD1 = marginal reflex distance 1; MRD2 = marginal reflex distance 2; MND = marginal nose distance. * Paired t-test, p < 0.05 compared to last follow-up; † Paired t-test, p < 0.05 compared to post 1 month.

  • Figure 5. Lower eyelid position presenting marginal reflex distance 2 of the lower eyelid following lower blepharoplasty using in-dividualized technique. Pre = pre-operation; Post = post-operation; CPF = capsulopalpebral fascia; SOOF = suborbicularis oculi fat; LCT = lateral canthal tendon. * Wilcoxon signed rank test: p < 0.05 compared to the last follow-up; † Wilcoxon signed rank test: p < 0.05 compared to postoperative 1 month.

  • Figure 6. Lower eyelid position presenting marginal nose distance of the lower eyelid following lower blepharoplasty using in-dividualized technique. Pre = pre-operation; Post = post-operation; CPF = capsulopalpebral fascia; SOOF = suborbicularis oculi fat; LCT = lateral canthal tendon, * Wilcoxon signed rank test: p < 0.05 compared to last follow-up; † Wilcoxon signed rank test: p < 0.05 compared to postoperative 1 month.


Cited by  3 articles

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Effect of Transconjunctival Approach Lower Blepharoplasty Combined with Pinch Skin Excision Technique in Elderly Patients
Boyoon Choi, Sungwon Yang, Jinhwan Park, Hwa Lee, Sehyun Baek
J Korean Ophthalmol Soc. 2019;60(3):205-209.    doi: 10.3341/jkos.2019.60.3.205.

Changes in Tear Meniscus Height Following Lower Blepharoplasty as Measured by Optical Coherence Tomography
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Korean J Ophthalmol. 2018;32(5):344-352.    doi: 10.3341/kjo.2017.0125.


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