Subtle Eyelid Retraction after Lower Blepharoplasty

Lower blepharoplasty is one of the commonest cosmetic surgeries performed in the United States. The delicate balance of the lower eyelid may be detrimentally altered in lower blepharoplasty, leading to lower eyelid retraction with the attendant functional and cosmetic consequences. Marginal reflex distance-2 (MRD2) is an insensitive measure for subtle lower eyelid retraction, and the MRD2 at the lateral limbus (MRD2_limbus) and tarsal marginal show (TMS) may be more sensitive in identifying eyelid retraction and eversion.

This is a cohort study of consecutive patients undergoing lower blepharoplasty with skin pinch removal, laser resurfacing, or skin pinch removal with prophylactic lateral canthal resuspension. Mean follow-up was 22.1 weeks.

There was no significant difference in MRD2 after surgery after either laser resurfacing, skin pinch, or skin pinch with canthoplasty, either after surgery or between groups. MRD2_limbus was significantly increased after surgery in the skin pinch only group (p < 0.05). There was a significant difference in postoperative MRD2_limbus in the skin pinch with canthoplasty group compared to that in the skin pinch only group (p < 0.05). TMS was significantly increased after both laser resurfacing (p < 0.001) and skin pinch only (p < 0.05), and both postoperative groups demonstrated significantly increased TMS compared to skin pinch with canthoplasty (p < 0.05).

MRD2_limbus and TMS are more sensitive markers for lower eyelid retraction than MRD2. Subtle eyelid retraction and eversion occur after anterior lamellar work and can be prevented with prophylactic lateral canthal resuspension.