J Korean Ophthalmol Soc.  2019 Apr;60(4):303-307. 10.3341/jkos.2019.60.4.303.

The Importance of Lower Eyelid Position in Aging Blepharoplasty

• Kim J
• Yang S
• Park J
• Lee H
• Baek S

• KMID: 2443145
• DOI: http://doi.org/10.3341/jkos.2019.60.4.303

Abstract

PURPOSE
To investigate the changes in upper and lower eyelid positions after upper blepharoplasty in elderly patients.
METHODS
Patients diagnosed with dermatochalasis and treated with upper blepharoplasty were included in the study. Clinical photographs taken preoperatively and immediately after surgery were retrospectively reviewed. Marginal reflex distance (MRD) 1, MRD2 and palpebral fissure height (PFH) were measured from the photographs using Image J software.
RESULTS
A total of 184 patients (72 males and 112 females) were included in the study. The preoperative mean MRD1, MRD2, and PFH were 1.97 ± 1.27 mm, 4.74 ± 0.97 mm, and 6.70 ± 1.69 mm, respectively. The postoperative mean MRD1, MRD2, and PFH were 1.79 ± 0.79 mm, 4.16 ± 0.92 mm, and 5.95 ± 1.36 mm, respectively. Preoperative and postoperative MRD1 were not significantly different (p = 0.256), but the postoperative MRD2 and PFH significantly decreased compared to preoperative values (both, p < 0.001).
CONCLUSIONS
When performing upper blepharoplasty in elderly patients, the surgeon should consider that the MRD2 and PFH could be decreased during surgery. When the surgeon estimates the correct amount of skin-muscle excision, the MRD1, but not PFH, should be considered.

Keyword

Blepharoplasty; Lower eyelid position; Marginal reflex distance 1; Marginal reflex distance 2; Palpebral fissure height

MeSH Terms

Aged
Aging*
Blepharoplasty*
Eyelids*
Humans
Male
Reflex
Retrospective Studies

Figure

• 

  Figure 1 Marginal reflex distance 1 (MRD1), MRD2 and palpebral fissure height (PFH). MRD1 is the distance from the corneal light reflex to the level of the upper eyelid margin. MRD2 is the distance from the corneal light reflex to the level of the lower eyelid margin. PFH is the distance from the level of the upper eyelid margin to the level of the lower eyelid margin.

• 

  Figure 2 A case of 61-year old male patient. (A) Preoperative photograph. Marginal reflex distance 1 (MRD1), MRD2, and palpebral fissure height (PFH) of right eye was 2.90 mm, 5.60 mm, and 8.50 mm, respectively. (B) Postoperative photograph. MRD1, MRD2, and PFH of right eye was 2.19 mm, 3.01 mm, and 5.20 mm, respectively. The arrows show that reverse ptosis was worsened immediately after surgery compared with preoperative status.

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