A Stepwise Management Strategy for Treatment of Iatrogenic Upper Eyelid Retraction in Eastern Asian Eyelids

Incidence of iatrogenic upper eyelid retraction (UER) caused by blepharoptosis overcorrection and improper blepharoplasty is increasing fast among Eastern Asians. The aim of this study is to present our experience using techniques of pretarsal cicatrix release, recession of levator-Müller's muscle complex, and lengthening of levator-Müller's muscle complex to correct mild to severe UER, and evaluate their anesthetic surgical outcomes.

Patients with UER who underwent surgical repair using the stepwise management strategy from December 2018 to June 2022 were retrospectively reviewed. This stepwise strategy was comprised four methods: releasing or unfolding the pretarsal cicatrix/levator aponeurosis, recessing the levator-Müller's muscle complex, lengthening the levator-Müller's muscle complex and creating an orbital fat flap. Pre- and postoperative clinical symptoms, upper eyelid marginal reflex distance (MRD₁), and eyelid symmetry were analyzed for outcome evaluation.

The stepwise management strategy was applied to 264 eyelids in 212 patients, including 45 men (21.23%) and 167 women (78.77%). Their age ranged from 19 to 64 years old (mean, 28.6 years), and the follow-up period ranged from 6 to 36 months (mean, 19.4 months). Among these patients, 52 underwent bilateral repair and the rest (160) underwent unilateral repair. UER caused by the blepharoptosis overcorrection and the improper blepharoplasty were categorized in 115 and 149 cases, respectively. MRD₁ deceased postoperatively regardless of the severity of retraction (p < 0.01). 88.20% of the patients achieved good or fair symmetry, and clinical symptoms were relieved in > 90% of the patients.

Our stepwise management surgical strategy, serving as a decision-making policy that ensures simple and proper repair, is capable of effectively correcting mild to severe iatrogenic UER, relieving clinical symptoms, and achieving favorable anesthetic surgical outcomes in patients caused by blepharoptosis overcorrection and improper blepharoplasty.

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