Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

Jung Hyo Ahn; Sang Yoon Han; Jae Woo Jang

doi:10.3341/jkos.2014.55.11.1579

Journal List > J Korean Ophthalmol Soc > v.55(11) > 1007891

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Ahn, Han, and Jang: Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(11):1579-1583.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.11.1579

Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

Jung Hyo Ahn, MD¹, Sang Yoon Han, MD², Jae Woo Jang, MD, PhD²

¹Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

²Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea

Address reprint requests to Jae Woo Jang, MD, PhD, Department of Ophthalmology, Konyang University Kim's Eye Hospital, #136 Yeongsin-ro, Yeongdeungpo-gu, Seoul 150-034, Korea, Tel: 82-2-2639-7811, Fax: 82-2-2633-3976, E-mail: jjw@kimeye.com

Received 21 June 2014 Revised 6 August 2014 Accepted 16 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate height and symmetry of double folds following simultaneous levator palpebral muscle resection and double eyelid blepharoplasty for correction of blepharoptosis.

Methods

We retrospectively studied 400 eyes of 286 patients who underwent simultaneous surgeries for double eyelid construction and correction of blepharoptosis from January 2006 to December 2011. All the patients were divided into three groups based on levator palpebrae muscle function: group A consisted of 82 eyes whose Levator Function Test (LFT) was 5 cm or less, group B consisted of 115 eyes whose LFT was between 5 and 10 cm, group C consisted of 203 eyes whose LFT was over 10 cm. For each group, we evaluated the preoperative marginal reflex distance 1 (MRD1), surgical methods, the postoperative height and symmetry of the double folds, and additional operations for correcting blepharoptosis.

Results

Blepharoptosis surgery was performed in all groups by simultaneous levator resection and double eyelid blepharoplasty in all groups. Postoperative asymmetric double fold was the most common outcome observed in the poor levator function group A. Blepharoptosis under-correction was the most common cause of asymmetric double fold and its occurrence was statistically different between the three groups. The other causes were skin redundancy, brow elevation, double fold loosening, and blepharoptosis over-correction.

Conclusions

The height of a double eyelid can be changed postoperatively by changing levator palpebrae muscle function. In cases of poor levator function, the levator palpebrae muscle is positioned slightly lower than the normal double fold. This condition may result in further relapse or recurrence in the poor levator function group. Also, levator function should be considered among the diverse factors that determine the height of the double fold.

Keywords: Blepharoptosis, Double eyelid blepharoplasty, Double fold, Levator palpebral muscle function

References

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Table 1.

Dermographics and surgical methods of blepharoptosis patients

	Mean age (years)	Bilaterality:Unilaterality (eyes)	Preoperative MRD1 (mm)	Surgical methods
Group A (n = 82)	26.2 ± 20.1	18:46	−0.05 ± 1.31	LR + DF: 39
Group A (n = 82)	26.2 ± 20.1	18:46	−0.05 ± 1.31	FS + DF: 43
Group B (n = 115)	37.3 ± 23.1	25:65	0.23 ± 0.01	LR + DF: 73
Group B (n = 115)	37.3 ± 23.1	25:65	0.23 ± 0.01	LA + DF: 6
Group C (n = 203)	34.3 ± 18.5	71:61	0.75 ± 0.87	LR + DF: 157
Group C (n = 203)	34.3 ± 18.5	71:61	0.75 ± 0.87	LA + DF: 46

Values are presented as mean ± SD unless otherwise indicated.

MRD1 = marginal reflex distance 1; LR = levator resection; DF = double fold operation; FS = frontalis suspension; LA = levator advancement.

Table 2.

Comparisons of asymmetric double fold between three groups

	Asymmetry of DF					Total (%)
	Ptosis under-correction	Skin redundancy	DF loosening	Ptosis over-correcton	Brow elevation	Total (%)
Group A	16 (88.8)	0	2 (11.2)	0	0	18/82 (21.9)
Group B	21 (95.4)	0	1 (4.6)	0	0	22/115 (19.2)
Group C	28 (84.9)	1 (3)	1 (3)	2 (6.1)	1 (3)	33/203 (16.3)
p-value	0.006^∗	−	−	−	−	−

DF = double fold.

^∗ Kruskal-Wallis test.

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