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Original Investigation |

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

Babar Sultan, MD1; Dane J. Genther, MD2; Stephen W. Perkins, MD3,4
[+] Author Affiliations
1Sultan Facial Plastic and Reconstructive Surgery, Towson, Maryland
2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
3Meridian Plastic Surgeons, Indianapolis, Indiana
4Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis
JAMA Facial Plast Surg. Published online July 07, 2016. doi:10.1001/jamafacial.2016.0673
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Importance  Transcutaneous 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 Participants  This 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.

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Figures

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Figure 1.
Orbicularis Oculi Suspension Suture

A, The periosteum of the lateral orbital rim at the level of the tubercle is grasped with a 5-0 Monocryl suture. B, The suture is passed through the orbicularis oculi muscle on the skin-muscle flap. C, The lower eyelid is suspended.

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Figure 2.
Eyelid Measurements

Measurements were made from the center of the pupil to the lower eyelid margin (A) and from the lateral limbus at the same vertical height as the center of the pupil to the lower eyelid margin (B).

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Figure 3.
Preoperative and Postoperative Photographs With Fat Transposition

A, Preoperative photograph of a patient who underwent skin-muscle flap lower eyelid blepharoplasty with fat transposition. B, Postoperative photograph shows the change in lower eyelid position and dry eyes.

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Figure 4.
Preoperative and Postoperative Photographs With and Without Fat Transposition

A, Preoperative photograph of a patient who underwent skin-muscle flap lower eyelid blepharoplasty. B, Postoperative photograph shows removal of pseudoherniated fat and correction of vertical skin excess. C, Preoperative photograph of a patient who underwent skin-muscle flap lower eyelid blepharoplasty with fat transposition. A deep medial nasojugal groove is present. D, Postoperative photograph shows effacement of the contour abnormality after fat transposition.

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