Cosmetic outcome of posterior approach ptosis surgery (an American Ophthalmological Society thesis).

Purpose: To test the hypothesis that posterior approach ptosis surgery, with or without blepharoplasty, can improve the cosmetic appearance of the eyelid.

Methods: In a retrospective, observational, consecutive case cohort study, 261 patients who had posterior approach upper eyelid ptosis surgery with or without concurrent blepharoplasty performed by one surgeon, between 1997 and 2009, were reviewed. Patients were included if they had symmetric eyelid position within 1.5 mm at 3 months after surgery. Outcome measures were subjective grading of eyelid margin contour, millimeters of tarsal platform show (TPS), and millimeters of eyebrow fat span (BFS). Paired preoperative and postoperative standardized photographs were viewed in masked fashion by three experts.

Results: One hundred and forty patients (55 men, 85 women, mean age 70 years, range 20-93) who underwent 233 posterior approach procedures for correction of upper eyelid ptosis had postoperative eyelid symmetry within 1.5 mm. Concurrent blepharoplasty was performed in 67 cases. Eyelid contour scores were significantly improved following surgery (P=.009). Ptosis surgery, without blepharoplasty, decreased the TPS, from 6.1±2.5 mm to 4.8±2.0 mm (P<.001). Patients who underwent concurrent blepharoplasty had a statistically insignificant increase of TPS from 4.0±3.5 mm to 4.3±3.6 mm, had a decrease of BFS from 20.8±6.3 mm to 17.7±6.4 mm (P=.001), and showed similar BFS symmetry postoperatively, compared to patients who had ptosis surgery only.

Conclusions: posterior approach surgery alone was often successful in controlling TPS: it shortened the TPS. Blepharoplasty combined with posterior approach ptosis surgery tended to lengthen the TPS and shorten the BFS.