Zhou Xianyu, Dong Xue, Yuan Zhaoqi, Qiu Yucheng, Liu Fei, Yang Jun
Department of Plastic and Reconstructive Surgery, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Doctor's Office, 16th Floor of the First Building, 639 Zhi Zao Ju Road, Shanghai, People's Republic of China.
Division of Plastic Surgery, The First Hospital, Jilin University, Changchun, People's Republic of China.
Aesthetic Plast Surg. 2025 Aug 25. doi: 10.1007/s00266-025-05137-8.
Incidence of iatrogenic upper eyelid retraction (UER) caused by blepharoptosis overcorrection and improper blepharoplasty is increasing fast among Eastern Asians. The aim of this study is to present our experience using techniques of pretarsal cicatrix release, recession of levator-Müller's muscle complex, and lengthening of levator-Müller's muscle complex to correct mild to severe UER, and evaluate their anesthetic surgical outcomes.
Patients with UER who underwent surgical repair using the stepwise management strategy from December 2018 to June 2022 were retrospectively reviewed. This stepwise strategy was comprised four methods: releasing or unfolding the pretarsal cicatrix/levator aponeurosis, recessing the levator-Müller's muscle complex, lengthening the levator-Müller's muscle complex and creating an orbital fat flap. Pre- and postoperative clinical symptoms, upper eyelid marginal reflex distance (MRD), and eyelid symmetry were analyzed for outcome evaluation.
The stepwise management strategy was applied to 264 eyelids in 212 patients, including 45 men (21.23%) and 167 women (78.77%). Their age ranged from 19 to 64 years old (mean, 28.6 years), and the follow-up period ranged from 6 to 36 months (mean, 19.4 months). Among these patients, 52 underwent bilateral repair and the rest (160) underwent unilateral repair. UER caused by the blepharoptosis overcorrection and the improper blepharoplasty were categorized in 115 and 149 cases, respectively. MRD deceased postoperatively regardless of the severity of retraction (p < 0.01). 88.20% of the patients achieved good or fair symmetry, and clinical symptoms were relieved in > 90% of the patients.
Our stepwise management surgical strategy, serving as a decision-making policy that ensures simple and proper repair, is capable of effectively correcting mild to severe iatrogenic UER, relieving clinical symptoms, and achieving favorable anesthetic surgical outcomes in patients caused by blepharoptosis overcorrection and improper blepharoplasty.
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在东亚人群中，因睑下垂矫正过度及睑成形术不当导致的医源性上睑退缩（UER）发生率正迅速上升。本研究的目的是介绍我们使用睑板前瘢痕松解、提上睑肌 - 米勒肌复合体后徙以及提上睑肌 - 米勒肌复合体延长技术来矫正轻至重度UER的经验，并评估其麻醉手术效果。
回顾性分析2018年12月至2022年6月期间采用逐步管理策略进行手术修复的UER患者。该逐步策略包括四种方法：松解或展开睑板前瘢痕/提上睑肌腱膜、提上睑肌 - 米勒肌复合体后徙、提上睑肌 - 米勒肌复合体延长以及制作眶脂瓣。分析术前和术后的临床症状、上睑缘反射距离（MRD）和眼睑对称性以评估结果。
逐步管理策略应用于212例患者的264只眼睑，其中男性45例（21.23%），女性167例（78.77%）。年龄范围为19至64岁（平均28.6岁），随访期为6至36个月（平均19.4个月）。其中，52例接受双侧修复，其余160例接受单侧修复。因睑下垂矫正过度和睑成形术不当导致的UER分别为115例和149例。无论退缩程度如何，术后MRD均降低（p < 0.01）。88.20%的患者实现了良好或中等的对称性，超过90%的患者临床症状得到缓解。
我们的逐步管理手术策略作为一种确保简单且恰当修复的决策策略，能够有效矫正轻至重度医源性UER，缓解临床症状，并在因睑下垂矫正过度和睑成形术不当导致的患者中取得良好的麻醉手术效果。
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