What Is the Best Way to Handle the Involutional Blepharoptosis Repair?

Abstract

There are many different operations to correct involutional blepharoptosis (IB); however, the outcome of the corrective surgery is rather unpredictable, regardless of the procedure employed. A reasonably predictable outcome can be achieved with careful intraoperative evaluation of the condition, with measuring of the margin reflex distance-1 (MRD-1) in supine position of the patients. With these prepositions, we collected data that indicated that our approach can achieve a predictable outcome. This was a prospective study of 21 consecutive patients (8 men and 13 women) involving 42 eyelids with IB. IB was defined as an MRD-1 of <2 mm. All 21 patients were informed of the purposes of the study, and underwent levator aponeurosis advancement. The MRD-1 was measured intraoperatively with the patients in a supine position and in the 3-month postoperative inspection with the patients in a sitting position. Statistical analyses using paired t-tests were performed. From intraoperative measurement, mean MRD-1 values were 4.31 mm on the right side (range 3.0-4.5) and 4.29 mm on the left side (range 3.5-5.0). Three months after the operations, mean MRD-1 values were 3.07 mm on the right side (range 1.5-4.0) and 3.07 mm on the left side (range 2.0-4.0). Compared with the intraoperative MRD-1 measurements, those of the postoperatives were significantly 1.2 mm reduced (right: P < 0.01, left: P < 0.01). The intraoperative measurement of MRD-1 without changing position of patients could result in successful outcome of the operation.

Digital Image Analyses of Preoperative Simulation and Postoperative Outcome following Blepharoptosis Surgery

“…Advancement of the levator aponeurosis is the most commonly used procedure to effectively treat involutional blepharoptosis. 5 , 6 A restoration of the upper visual field and an improvement and rejuvenation of the facial appearance after the surgery are greatly appreciated by the patients. The most appreciated cosmetic changes following blepharoptosis surgery are the elevation of the upper eyelid as quantified by the increase in the margin reflex distance (MRD-1) and the formation of the upper eyelid crease known as a double eyelid crease, which can be quantified by the pretarsal show (PTS).…”

Age-related eyelid changes

“…3B, 4). In this technique, the levator aponeurosis is detached from the tarsus, followed by separation from the Müller muscle and post-septal fat pad [9]. The levator aponeurosis is then advanced and fixed with one to www.jcosmetmed.org three sutures to the tarsus.…”