Korean J Ophthalmol.  2013 Feb;27(1):1-6. 10.3341/kjo.2013.27.1.1.

Blepharoptosis Repair through the Small Orbital Septum Incision and Minimal Dissection Technique in Patients with Coexisting Dermatochalasis

• Jung Y
• La TY

• KMID: 1501788
• DOI: http://doi.org/10.3341/kjo.2013.27.1.1

Abstract

PURPOSE
To describe a modified surgical technique for blepharoptosis repair through a small orbital septum incision and minimal dissection, along with the results obtained in patients with coexisting dermatochalasis.
METHODS
A retrospective chart review included 33 patients (52 eyelids) with blepharoptosis coexisting with dermatochalasis, surgically corrected through a small orbital septum incision and minimal dissection after redundant upper lid skin excision, by placing a single fixation suture between the levator aponeurosis and the tarsal plate. Outcome measures included the pre- and postoperative marginal reflex distances (MRD1), eyelid contour, post-operative complications, and need for reoperation.
RESULTS
The pre- and postoperative MRD1 averaged 1.1 +/- 0.8 mm and 2.8 +/- 1.1 mm, respectively. Of the 33 patients, 9 patients (9 eyelids) underwent surgery on one eyelid for unilateral blepharoptosis and dermatochalasis (Group I), 5 patients (5 eyelids) underwent a simple skin excision blepharoplasty of the contralateral eyelid (Group II), and 19 patients (38 eyelids) underwent bilateral blepharoptosis and dermatochalasis repair (Group III). Of the 14 eyelids that underwent unilateral ptosis repair (Groups I and II), 12 eyelids (85.7%) showed less than a 1-mm difference from the contralateral eyelid. Of the 38 eyelids that underwent bilateral ptosis repair (Group III), 27 eyelids (71.1%), 5 eyelids (13.1%), and 6 eyelids (15.8%) had excellent, good, and poor outcomes, respectively. Overall, 44 eyelids (84.6%) out of a total of 52 eyelids had successful outcomes; the remaining 8 eyelids demonstrated unsatisfactory eyelid contour was corrected by an additional surgery.
CONCLUSIONS
Blepharoptosis repair through a small orbital septum incision and minimal dissection can be considered an efficient technique in patients with ptosis and dermatochalasis.

Keyword

Blepharoptosis; Dermatochalasis; Minimal dissection; Small incision

MeSH Terms

Aged
Aged, 80 and over
Blepharoplasty/*methods
Blepharoptosis/*surgery
Dissection/*methods
Eyelids/*surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Oculomotor Muscles/surgery
Orbit/*surgery
Retrospective Studies
*Sutures
Treatment Outcome

Figure

• 

  Fig. 1 Procedure for blepharoptosis correction and redundant skin excision through the small orbital septum incision and minimal dissection technique. (A) A skin marking was made along the natural lid crease line and the redundant skin to be excised was designed. (B) The redundant skin and the underlying orbicularis muscle were excised. (C) After incising the orbital septum for about a length of 10 mm just above the tarsal plate, the pretarsal orbicularis muscle was dissected until the tarsal plate was exposed across the same width. (D) By dissecting in an upward direction from the tarsal plate, the preaponeurotic fat pad was identified and the levator aponeurosis was exposed till the level of musculo-aponeurotic junction. (E) A partial thickness suture of more than 5 mm in width was placed through the tarsal plate in a horizontal fashion. (F) A double-armed, non-absorbable suture was passed through the levator aponeurosis at a predetermined position. (G) The permanent fixation suture was tied down after inspecting the eyelid height and contour. (H) Finally, the skin was closed with interrupted sutures of 6-0 black silk.

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  Fig. 2 Preoperative and postoperative photographs of patient (at 2 months). Preoperative (A) and postoperative (B) pictures of a patient from Group I (left eye). Preoperative (C) and postoperative (D) pictures of a patient from Group II (left eye). Preoperative (E,G) and postoperative (F,H) pictures of patients from Group III, respectively. Group I: operation for unilateral ptosis and dermatochalasis. Group II: operation for unilateral ptosis and dermatochalasis + redundant skin excision only of contralateral eyelid. Group III: operation for bilateral ptosis and dermatochalasis.

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