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

Abstract

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.