Upper Blepharoplasty with Concurrent Ptosis Correction: A Safe and Effective Procedure

BACKGROUND: The diagnosis of ptosis in the setting of dermatochalasis is important for proper surgical management. To alleviate visual field obstruction, formal ptosis correction with upper blepharoplasty is necessary. There is debate whether ptosis correction can be safely done in conjunction with upper blepharoplasty. The incidence of overcorrection has been reported to be 1.3% in the literature.1 In this study, we report our experience with upper blepharoplasty combined with eyelid ptosis repair. METHODS: A retrospective review of patients who underwent primary upper blepharoplasty combined with ptosis correction between January 2019 and March 2020 at our institution was performed. Patients with endocrine, autoimmune, or neurovascular disorders that may affect upper eyelid function were excluded. Patient demographics, clinical presentation, surgical management, and outcomes (including revision) were recorded. Univariate time-to-event analysis using Cox-proportional hazards model was performed to assess predictors of revision surgery. RESULTS: Overall, 59 patients with 98 primary upper blepharoplasties combined with ptosis corrections were included. Mean age was 70.3 years (SD: 8.8 years). Mean follow-up was 3.3 months (SD: 5 months). Thirty-six (61%) patients had hypertension, 48 (81.4%) had dyslipidemia, 11 (18.6%) had diabetes mellitus, and 15 (25.4%) had coronary artery disease. Twenty (33.9%) patients were former smokers, and 1 (1.7%) patient was an active smoker. In 34 (34.7%) cases, a brow lift was also performed. Fifty-four (55.1%) of the ptosis corrections involved the Müller’s muscle conjunctival resection technique, whereas 44 (44.9%) needed levator repair. There were no wound healing complications. New dry eye symptoms lasting ≥3 months occurred in four (4.1%) cases, all of which resolved. No vision loss, corneal abrasion, or diplopia occurred. Revision surgery was performed in 10 (10.2%) cases. These were indicated due to residual excess skin/tissue (n = 5), overcorrection (n = 4), and asymmetry (n = 1). In three of these overcorrection incidences, patients had undergone levator repair, whereas the remaining had undergone Müller’s muscle conjunctival resection; however, there was no significant association between the ptosis correction technique and having a ptosis revision due to overcorrection. No statistically significant association was identified between the variables and having a revision surgery. CONCLUSIONS: Upper blepharoplasty combined with eyelid ptosis correction is safe and yields satisfactory results with minimal complication rates in this population with increased age and multiple comorbidities. The rate of revision with regard to ptosis correction or upper blepharoplasty was 10.2% in our cohort. Care must be taken to prevent the incidence of overcorrection after ptosis repair leading to revision, as it was the case in 4.1% of the cases in our cohort. This was comparable to prior studies. Larger studies with higher power are required to better identify predictors of revision after upper blepharoplasty combined with eyelid ptosis correction. REFERENCE: 1. Chou E, Liu J, Seaworth C, et al. Comparison of revision rates of anterior- and posterior-approach ptosis surgery: a retrospective review of 1519 cases. Ophthalmic Plast Reconstr Surg. 2018;34(3):246–253. doi:10.1097/IOP.0000000000000938.