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Updated: Dec 27, 2025
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Published on: April 17, 2019
Changes in Lid Crease Measurements in Levator Advancement for Ptosis
Amena Alkeswani1, Felicia Hataway, Brian Westbrook
1From the Department of Surgery, Division of Plastic Surgery, University of Alabama Birmingham, Birmingham, AL.
Purpose:
Although previous reports addressed the differences in marginal reflex distance 1 (MRD-1) measurements based on various techniques of levator advancement, eyelid crease measurements have not been studied as markers in perioperative planning. In addition to possible benefits in optimal results for improvement of visual field defects and functional impairment, recent work has suggested that eyelid crease is important in the perception of attractiveness. Therefore, the aims of this study were to determine the change in eyelid crease measurements in levator advancement and to further expand on numerical correlation of levator advancement in preoperative planning to avoid overcorrection or undercorrection.
Methods:
The authors performed a retrospective analysis of preoperative and postoperative eye measurements in patients who underwent levator advancement for ptosis between August 2016 and April 2019. This study included 13 patients, all of whom had recorded preoperative and postoperative measurements of MRD-1, whereas 8 of 13 patients had additional preoperative and postoperative measurements of the mid pupil to crease and lateral limbus to crease at the level of mid pupil.
Results:
All patients had increased in MRD-1, mid pupil to crease, and lateral limbus to crease measurements postoperatively. The average advancement of 4.8 mm led to an elevation of MRD-1 to 2.6 mm (n = 25) and an improvement in mid pupil to crease distance of 1.9 mm (n = 15) and lateral limbus to crease distance of 2.6 mm (n = 15). No cases of undercorrection or overcorrection were found. All patients reported satisfaction with the results, including improvement in function and quality of life. No infections, hematomas, or other complications were noted postoperatively in any of the patients.
Conclusions:
Marginal reflex distance 1 is a consistently reliable planning tool in preoperative assessment of levator advancement, with beneficial patient outcomes including improvement of visual field defects caused by ptosis and satisfaction with cosmetic results. This study is the first to report use of crease measurements (mid pupil to crease and lateral limbus to crease), which may provide additional understanding to the aesthetic value of to the levator advancement.
