Department of Otolaryngology-Head and Neck Surgery, Temple University Hospital, 3440 N. Broad Street, Philadelphia, PA 19140, United States.
Eye and Facial Plastic Surgery Consultants, 1717 Langhorne-Newtown Road, Suite 150, Langhorne, PA 19047, United States; Scheie Eye Institute, Division of Oculoplastics, 51 N 39th Street, Philadelphia, PA 19104, United States.
J Plast Reconstr Aesthet Surg. 2019 Oct;72(10):1682-1687. doi: 10.1016/j.bjps.2019.06.024. Epub 2019 Jun 27.
Lower blepharoplasty is one of the commonest cosmetic surgeries performed in the United States. The delicate balance of the lower eyelid may be detrimentally altered in lower blepharoplasty, leading to lower eyelid retraction with the attendant functional and cosmetic consequences. Marginal reflex distance-2 (MRD2) is an insensitive measure for subtle lower eyelid retraction, and the MRD2 at the lateral limbus (MRD2) and tarsal marginal show (TMS) may be more sensitive in identifying eyelid retraction and eversion.
This is a cohort study of consecutive patients undergoing lower blepharoplasty with skin pinch removal, laser resurfacing, or skin pinch removal with prophylactic lateral canthal resuspension. Mean follow-up was 22.1 weeks.
There was no significant difference in MRD2 after surgery after either laser resurfacing, skin pinch, or skin pinch with canthoplasty, either after surgery or between groups. MRD2 was significantly increased after surgery in the skin pinch only group (p < 0.05). There was a significant difference in postoperative MRD2 in the skin pinch with canthoplasty group compared to that in the skin pinch only group (p < 0.05). TMS was significantly increased after both laser resurfacing (p < 0.001) and skin pinch only (p < 0.05), and both postoperative groups demonstrated significantly increased TMS compared to skin pinch with canthoplasty (p < 0.05).
MRD2 and TMS are more sensitive markers for lower eyelid retraction than MRD2. Subtle eyelid retraction and eversion occur after anterior lamellar work and can be prevented with prophylactic lateral canthal resuspension.
下眼睑成形术是美国最常见的美容手术之一。下眼睑的精细平衡可能在下眼睑成形术中受到不利影响，导致下眼睑退缩，并伴有相应的功能和美容后果。Marginal Reflex Distance-2（MRD2）是一种对轻微下眼睑退缩不敏感的测量方法，而外侧角膜缘的 MRD2（MRD2）和睑缘显示（TMS）可能更敏感，可识别眼睑退缩和翻转。
这是一项连续患者的队列研究，这些患者接受下眼睑成形术，伴有皮肤夹移除、激光换肤或皮肤夹移除伴预防性外侧眦悬吊术。平均随访 22.1 周。
激光换肤、皮肤夹或皮肤夹联合眦成形术后的 MRD2 均无显著差异，无论是术后还是组间均无显著差异。仅皮肤夹组术后 MRD2 显著增加（p<0.05）。皮肤夹联合眦成形术组的术后 MRD2 与仅皮肤夹组有显著差异（p<0.05）。TMS 在激光换肤后（p<0.001）和仅皮肤夹（p<0.05）后均显著增加，且术后两组的 TMS 均明显高于皮肤夹联合眦成形术组（p<0.05）。
MRD2 和 TMS 比 MRD2 更能敏感地标记下眼睑退缩。在前层工作后会发生轻微的眼睑退缩和翻转，并可通过预防性外侧眦悬吊术来预防。
