The importance of lower eyelid position in aging blepharoplasty

Purpose: To investigate the changes in upper and lower eyelid positions after upper blepharoplasty in elderly patients. Methods: Patients diagnosed with dermatochalasis and treated with upper blepharoplasty were included in the study. Clinical photographs taken preoperatively and immediately after surgery were retrospectively reviewed. Marginal reflex distance (MRD) 1, MRD2 and palpebral fissure height (PFH) were measured from the photographs using Image J software. Results: A total of 184 patients (72 males and 112 females) were included in the study. The preoperative mean MRD1, MRD2, and PFH were 1.97 ± 1.27 mm, 4.74 ± 0.97 mm, and 6.70 ± 1.69 mm, respectively. The postoperative mean MRD1, MRD2, and PFH were 1.79 ± 0.79 mm, 4.16 ± 0.92 mm, and 5.95 ± 1.36 mm, respectively. Preoperative and postoperative MRD1 were not significantly different (p = 0.256), but the postoperative MRD2 and PFH significantly decreased compared to preoperative values (both, p ＜ 0.001). Conclusions: When performing upper blepharoplasty in elderly patients, the surgeon should consider that the MRD2 and PFH could be decreased during surgery. When the surgeon estimates the correct amount of skin-muscle excision, the MRD1, but not PFH, should be considered.