The effect of upper blepharoplasty on eyelid position when performed concomitantly with Muller muscle-conjunctival resection

Purpose: To determine the effect on eyelid elevation of excising excess ski n, orbicularis oculi muscle, and herniated orbital fat and reconstructing t he upper eyelid crease (blepharoplasty) concomitant with a Muller muscle-co njunctival resection. Methods: The charts of 202 patients who had undergone Muller muscle-conjunc tival resection during an 8-year interval were reviewed. Three hundred fort y-five eyelids were divided into two groups. Group 1 (n = 162) underwent a Muller muscle-conjunctival resection only, and group 2 (n = 183) had this p rocedure combined with excision of skin, orbicularis muscle, and herniated orbital fat with upper eyelid crease reconstruction. Each group was divided into three subgroups based on the amount of Muller muscle-conjunctival res ection. Subgroup A had resection less than 7.75 mm; subgroup B, resection o f 7.75 to 8.75 mm; and subgroup C, resection greater than 8.75 mm. The chan ge in margin reflex distance-1 (MRD1) measurements of the upper eyelid leve ls (postoperative MRD1 minus preoperative MRD1) were calculated and compare d between groups. Results: The mean (+/- standard deviation) change in MRD1 was, respectively , 2.3 +/- 1.0 mm and 1.9 +/- 1.0 mm for groups 1A and 2A; 3.1 +/- 1.3 mm an d 2.1 +/- 1.2 mm for groups 1B and 2B; and 3.4 +/- 1.2 mm and 2.8 +/- 1.3 f or groups 1C and 2C. Conclusions: Blepharoplasty performed concomitant with a Muller muscle-conj unctival resection reduced the anticipated postoperative eyelid elevation b y as much as 1 mm. Surgeons who perform these procedures together should be aware that a larger Muller muscle-conjunctival resection may be required t o obtain the desired increase in eyelid height postoperatively.