Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

Young Je Sung; Jong Seo Park; Helen Lew

doi:10.3341/jkos.2015.56.12.1831

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Sung, Park, and Lew: Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

Original Article

J Korean Ophthalmol Soc 2015;56(12):1831-1839.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.12.1831

Changes in Lower Eyelid Positions after Individualized Lower Blepharoplasty

Young Je Sung, M.D, Jong Seo Park, M.D, Helen Lew, M.D, PhD

Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Address reprint requests to Helen Lew, MD, PhD Department of Ophthalmology, CHA Bundang Medical Center, CHA University, #59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea Tel: 82-31-780-5330, Fax: 82-31-780-5333 E-mail: eye@cha.ac.kr

‗ This study was presented as a narration at the 113th Annual Meeting of the Korean Ophthalmological Society 2015.

Received 29 May 20155 July 2015 Accepted 25 September 2015

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

Various forms and degrees of morphological changes in the lower eyelid are presented in this study. A compre-hensive, 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 pa-tient 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 anatomi-cal lower eyelid findings was performed.

Keywords: Eyelid position, Lower blepharoplasty

References

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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. MRD_1, 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.

Table 1.

Clinical parameters after lower blepharoplasty in total patients (n = 168)

	Pre	Post	p-value^*	Last F/U	p-value^*
MRD₁ (mm)	2.21 ± 1.08	2.39 ± 1.14	0.021	3.72 ± 1.19	0.005
MRD₂ (mm)	5.36 ± 1.15	4.92 ± 0.88	<0.001	4.96 ± 0.85	0.004
IPF (mm)	7.57 ± 1.53	7.31 ± 1.39	0.063	7.68 ± 1.40	0.706
MND (mm)	59.75 ± 17.56	64.19 ± 18.52	0.002	62.36 ± 16.71	0.003

Values are presented as mean ± SD unless otherwise indicated. Pre = pre-operation; Post = post-operation; F/U = follow up; MRD₁ = marginal reflex distance 1; MRD₂ = marginal reflex dis-tance 2; IPF = interpalpebral fissure; MND = marginal nose distance.^* Paired t-test.

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