• Archives of Plastic Surgery
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• 제49권4호
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• pp.473-478
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• 2022

Background We investigate the effect of involutional blepharoptosis (IB) surgery based on dry eye symptoms by analysis using objective and subjective measures. Methods We recorded various parameters from patients that underwent levator advancement surgery for IB, totaling 125 eyes (total 65 patients, 5 unilateral, 60 bilateral). Subjective assessment comprised a questionnaire on dry eye-related quality of life score (DEQS), a summary score calculated from DEQS, and six-grade evaluation, the patient's own measure of eye comfort. Objective assessment comprised marginal-reflex distance-1 (MRD-1), measurement of tear film breakup time, and superficial keratopathy (SPK) existence by slit lamp microscope. Results Subjective assessments showed that IB patients had improvement of dry eye symptoms and eye comfort when surgery increased MRD-1. On the other hand, objective assessments showed that the presence of SPK is suspected when the postoperative MRD-1 level is 3 mm or higher. Conclusion IB surgery must not only increase MRD-1 value, but also to perform maintenance of the appropriate ocular surface condition. From our parameters, we suggest postoperative MRD-1 value should be maintained at < 3 mm to safe and effective of IB surgery.

• Archives of Plastic Surgery
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• 제47권4호
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• pp.290-296
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• 2020

In many aging individuals, dermatochalasis and involutional ptosis appear together. Therefore, for functional and aesthetic purposes, ptosis correction and upper blepharoplasty are performed together. The aim of this article is to investigate factors that should be considered in order to achieve good results when simultaneously performing involutional ptosis correction and upper blepharoplasty in aging patients. Involutional ptosis is usually corrected through aponeurosis advancement in mild cases. In moderate or severe ptosis, the Muller muscle and aponeurosis are used together to correct ptosis. Using the two muscles together has the advantages of reducing lagophthalmos and increasing the predictability of outcomes after surgery. Broadly speaking, the surgical method used for involutional ptosis varies depending on the specific case, but unlike congenital ptosis, it is often not necessary to perform overcorrection. In particular, if there are problems such as severe dry-eye symptoms or risk of lagophthalmos, undercorrection should be considered. When performing ptosis correction, the surgeon should be careful not to overdo skin excision; instead, limited excision should be performed. After ptosis surgery, the brow may descend and the double fold may look too small. However, in order to make the double eyelids look larger, the surgeon should consider making the double eyelid design high rather than excising an excessive amount of skin. In some cases, to obtain more natural double eyelids and favorable results, it may be necessary to perform a sub-brow lift or forehead lift before or after involutional ptosis surgery.