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Subtle Eyelid Retraction after Lower Blepharoplasty.

Jonathan Harounian1, Allan E Wulc2, Alan B Brackup2

  • 1Department of Otolaryngology-Head and Neck Surgery, Temple University Hospital, 3440 N. Broad Street, Philadelphia, PA 19140, United States.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|August 25, 2019
PubMed
Summary

New measurements, marginal reflex distance-2 at the lateral limbus (MRD2limbus) and tarsal marginal show (TMS), are more sensitive for detecting lower eyelid retraction after blepharoplasty. Prophylactic canthal resuspension can prevent these issues.

Keywords:
BlepharoplastyCosmeticsEyelid retractionFaceOculoplasticsTear trough

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Area of Science:

  • Oculoplastics
  • Ophthalmic Plastic Surgery
  • Cosmetic Surgery

Background:

  • Lower blepharoplasty is a common cosmetic procedure.
  • Alterations in lower eyelid support can lead to retraction and functional/cosmetic issues.
  • Marginal reflex distance-2 (MRD2) is a standard but insensitive measure for subtle lower eyelid retraction.

Purpose of the Study:

  • To evaluate the sensitivity of MRD2 at the lateral limbus (MRD2limbus) and tarsal marginal show (TMS) in detecting lower eyelid retraction post-blepharoplasty.
  • To compare these measures with standard MRD2.
  • To assess the efficacy of prophylactic lateral canthal resuspension in preventing eyelid retraction.

Main Methods:

  • A cohort study of patients undergoing lower blepharoplasty (skin pinch, laser resurfacing, or skin pinch with canthal resuspension).
  • Follow-up averaged 22.1 weeks.
  • Measurements included MRD2, MRD2limbus, and TMS.

Main Results:

  • No significant difference in standard MRD2 was observed across surgical groups.
  • MRD2limbus significantly increased after skin pinch alone and was higher compared to the canthoplasty group.
  • TMS significantly increased after laser resurfacing and skin pinch alone, and was higher compared to the canthoplasty group.

Conclusions:

  • MRD2limbus and TMS are more sensitive indicators of lower eyelid retraction than standard MRD2.
  • Subtle eyelid retraction and eversion occur after anterior lamellar procedures.
  • Prophylactic lateral canthal resuspension effectively prevents these postoperative changes.