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Pathology Of "Post-Upper Blepharoplasty Syndrome": Implications For Upper Eyelid Reconstruction
Kenneth D Steinsapir1, Yoon-Duck Kim2
1Orbital and Ophthalmic Plastic Surgery Division, UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Clinical Ophthalmology (Auckland, N.Z.)
|December 6, 2019
Summary
Post-upper blepharoplasty syndrome involves levator aponeurosis disinsertion, causing eyelid ptosis and hollowness. Surgical repair requires identifying this disinsertion for effective correction.
Area of Science:
- Ophthalmology
- Plastic Surgery
- Anatomy
Background:
- The anatomical basis for eyelid changes after upper blepharoplasty remains under-investigated.
- Post-upper blepharoplasty syndrome (PUBS) is characterized by ptosis, hollow sulcus, absent crease, eyelash ptosis, and brow elevation.
Purpose of the Study:
- To investigate the anatomical basis of post-upper blepharoplasty syndrome.
Main Methods:
- Retrospective, case-controlled study comparing patients with blepharoptosis after cosmetic blepharoplasty (cases) to those who underwent ptosis surgery (controls).
- Surgical correction methods included levator aponeurosis resection, anchor blepharoplasty, and anterior orbital fat grafting.
- Morphologic and anatomical findings were compared between case and control eyelids.
Main Results:
- Analysis of 81 eyelids (42 patients) revealed significant internal anatomical differences despite similar external appearances.
- Eyelids with PUBS (n=48) showed white-line disinsertion of the levator aponeurosis, bound into septal scar tissue from fat removal.
- Levator disinsertion was not observed in control eyelids (n=33).
Conclusions:
- Hollowness and ptosis in PUBS are linked to levator aponeurosis disinsertion and fat matting within surgical scars.
- Accurate identification of the disinserted levator is crucial for successful surgical repair of post-blepharoplasty eyelids.
