Blepharoplasty Effect on a Described Algorithmic Approach to External Ptosis Repair: Is It Time for Unbundling?

Area of Science:

• Ophthalmology
• Plastic Surgery

Background:

• Involutional ptosis is a common condition requiring surgical correction.
• Levator resection is a primary surgical technique for ptosis repair.
• Blepharoplasty is often performed concurrently for aesthetic improvement.

Purpose of the Study:

• To evaluate the efficacy of an algorithmic external levator resection combined with blepharoplasty for involutional ptosis.
• To compare the outcomes of combined surgery versus small-incision ptosis repair.

Main Methods:

• The study included eyelids with involutional ptosis and normal levator function.
• An upper blepharoplasty was performed, followed by an external levator resection using a standardized algorithmic approach.
• Measurements included margin to reflex distance 1 (MRD1) to assess surgical outcomes.

Main Results:

• The combined procedure achieved a mean postoperative MRD1 of 2.98 mm, significantly improving upon the preoperative MRD1 of 0.67 mm.
• Eight eyelids (19.5%) did not meet the primary outcome of MRD1 within 1 mm of the goal (3.35 mm), with five cases of undercorrection.
• While postoperative MRD1 was comparable to small-incision repairs, the concurrent blepharoplasty group required more intraoperative adjustments and had fewer eyelids meeting the primary outcome.

Conclusions:

• Algorithmic external levator resection with concurrent blepharoplasty demonstrates an 80% success rate for involutional ptosis.
• Combining blepharoplasty with this ptosis repair technique results in less predictable outcomes and increased intraoperative adjustments compared to small-incision ptosis repair.
• Separating these procedures may be considered to enhance predictability and patient care outcomes.