RESUMO
BACKGROUND: We discovered severe ptosis patients developed infraduction after conjoint fascial sheath (CFS) suspension, a complication that is associated with this technique. In this article, the causes and outcomes of the infraduction after CFS suspension were systematically analyzed. METHODS: Seventy-four patients with severe ptosis who underwent CFS suspension between February 2020 and June 2021 were reviewed. The palpebral fissure height (PFH), the eyeball position, the infraduction and recovery distance, the eyeball position difference, and the cosmetic results were recorded and analyzed. RESULTS: Before surgery, the mean PFH, eyeball position, and cosmetic results were 6.33⯱â¯0.72â¯mm, 4.68⯱â¯0.80â¯mm, and 2.03⯱â¯0.96, respectively. The eyeball position difference was 0.70⯱â¯0.41â¯mm for unilateral ptosis patients and 0.58⯱â¯0.26â¯mm for bilateral ptosis patients. Immediately after surgery, the mean PFH, eyeball position, and cosmetic results were 12.73⯱â¯1.22â¯mm (Pâ¯<â¯0.0001), 3.01⯱â¯1.19â¯mm (Pâ¯<â¯0.0001), and 5.80⯱â¯1.53 (Pâ¯<â¯0.0001), respectively. The mean infraduction distance was 1.67⯱â¯1.04â¯mm. The mean eyeball position difference was 1.67⯱â¯1.18â¯mm (Pâ¯<â¯0.0001) for unilateral ptosis patients and 0.83⯱â¯0.52â¯mm for bilateral ptosis patients. At the last follow-up, the mean PFH, eyeball position, and cosmetic result were 10.46⯱â¯1.14â¯mm (Pâ¯<â¯0.0001), 4.19⯱â¯0.74â¯mm (Pâ¯<â¯0.0001), and 8.24⯱â¯1.36 (Pâ¯<â¯0.0001), respectively. The mean infraduction distance was 0.49⯱â¯0.48â¯mm, and the mean recovery distance was 1.18⯱â¯0.90â¯mm. The mean eyeball position difference was 0.71⯱â¯0.61â¯mm for unilateral ptosis patients and 0.49⯱â¯0.47â¯mm for bilateral ptosis patients. CONCLUSION: The impact on the superior rectus may lead to infraduction after CFS surgery. Patients developed infraduction immediately after surgery and recovered spontaneously. LEVEL OF EVIDENCE: IV.
RESUMO
BACKGROUND: Fifty percent of Asians are born without a supratarsal fold (also called single eyelid), and double eyelid blepharoplasty is one of the most commonly performed and most popular facial cosmetic surgeries in the Asian population. However, patients with single eyelid frequently present with concomitant mild blepharoptosis (degree of ptosis, ≤2 mm), which often fails to cause the attention of surgeons and misses correction. METHODS: A retrospective study of all patients who underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique was performed from June of 2017 to June of 2020. RESULTS: A total of 108 patients (155 eyelids) underwent double eyelid blepharoplasty and blepharoptosis correction simultaneously with the modified levator aponeurosis plication technique and were enrolled in the study. The average follow-up period was 11.8 ± 4.5 months. There was a statistically significant difference between the preoperative margin reflex distance 1 (MRD1) and postoperative MRD1 (2.93 ± 0.37 vs 4.21 ± 0.39 mm, P = 0.000), and the mean MRD1 improvement was 1.28 ± 0.50 mm. Sufficient correction was obtained in 148 eyelids (95.5%), whereas undercorrection was observed in 5 eyelids (3.2%) and overcorrection was observed in 2 eyelids (1.3%). One hundred two patients (94.4%) were completely satisfied with the final result.All patients had smooth and elegant upper eyelid margin curve, and no patients complained of distortion of the eyelid margin contour and foreign body sensation.There were no cases of hematoma, infection, suture exposure, corneal abrasion, and keratitis in any patient. CONCLUSIONS: This modified levator aponeurosis plication introduced in this study is a simple and effective method for creating double-eyelid crease and correcting mild blepharoptosis simultaneously, and provides a satisfactory outcome. As such, we recommend this method in treating patients with both single eyelid and mild blepharoptosis.