Clinical Measurement Analysis Of Eyelid Fissure Changes After Blepharoplasty

Background:Due to differences in ethnicity and upper eyelid structure,Chinese have varying degrees of upper eyelid bloating,canthus and weakness of the levator muscle,resulting in small eyelid fissures that affect the aesthetics of the eyes.To improve the appearance of smaller eyes,Chinese usually opt for blepharoplasty or a combination of other surgical procedures,making blepharoplasty one of the most common cosmetic surgeries in China.The subjective enlargement of the eyes after blepharoplasty results in a significant increase in patient satisfaction,but there are no specific measurements reported in the literature that visually reflect the enlargement of the eyelid fissure,and whether and how much it is enlarged.Objective:By measuring the ocular exposed area of the patient’s eyes before and after blepharoplasty,the changes in eyelid size and symmetry between the eyes before and after blepharoplasty were studied to provide clinicians with measurements to assess the results of blepharoplasty.Methods:A retrospective analysis of 273 clinical cases undergoing blepharoplasty from January2018 to September 2022 was performed,with only approximately 25% of patients followed up to 6 months and longer due to patient loss of care and other reasons,for a total of 82 patients,41 of whom underwent blepharoplasty alone,26 patients underwent blepharoplasty combined with epicanthoplasty,and 15 patients underwent blepharoplasty combined with anterior migration of the levator aponeurosis.All procedures were performed by the same senior surgeon,and all follow-up photographs were taken by the same photographer to ensure standardized conditions.The standardized photographs of all cases were measured by Image J Version 1.8.0 software,using the iris diameter as the standard unit,and the "Eyelid fissure area and corneal exposure rate" were recorded as "EFA,CER" and calculated as the normal reference range was then statistically analyzed using SPSS Version 26.0software to study the changes in eyelid size and symmetry before and after blepharoplasty and between the right and left eyes.Results:(1)In all patients who underwent blepharoplasty,the EFA was 1.21 ± 0.07 and CER(%)was 64.26 ± 2.58 in the preoperative group;the EFA was 1.36 ± 0.07 and CER(%)was84.76 ± 1.68 in the postoperative group,which were statistically different compared to both groups(p<0.001).This indicates that the patient’s postoperative eyelid fissure was significantly enlarged and that blepharoplasty significantly enlarged the patient’s eyelid fissure by an average of 11.03% postoperatively.(2)The increase in EFA(%)was 11.3±4.6 for blepharoplasty alone,13.1±4.0 for blepharoplasty combined with medial epicanthoplasty,and 13.8±5.8 for blepharoplasty combined with anterior migration of the levator aponeurosis,with a statistical difference between the three groups(p<0.05).When the post hoc LSD method was performed for a two-by-two comparison,there was a statistical difference between blepharoplasty alone and blepharoplasty combined with epicanthoplasty,and blepharoplasty combined with anterior migration of the levator aponeurosis,respectively(p<0.05).This suggests that blepharoplasty combined with epicanthoplasty and blepharoplasty combined with anterior migration of the levator aponeurosis has better surgical results than blepharoplasty alone in increasing the eyelid fissure.(3)In all patients who underwent blepharoplasty,the difference rates(%)of EFA in both eyes were 6.11±3.28 and CER in both eyes were 3.61±1.66 in the preoperative group;the difference rates(%)of EFA in both eyes were 2.21±1.24 and CER in both eyes were2.09±1.20 in the postoperative group,which were statistically different compared to both groups(p<0.001).The data all indicated that the eyelid discrepancy rate was significantly lower after blepharoplasty and that blepharoplasty significantly improved the symmetry of both eyes of the patients.Conclusion:(1)The " eyelid fissure area " measurement can be used to assess changes in eyelid size and bilateral symmetry after blepharoplasty,providing a useful way for plastic surgeons to assess changes in the eyelid after blepharoplasty.(2)All patients who underwent blepharoplasty had significantly larger postoperative eyelid fissures,and postoperative symmetry was significantly improved in both eyes.(3)The most significant postoperative enlargement was seen in patients who underwent blepharoplasty combined with anterior migration of the levator aponeurosis or blepharoplasty combined with epicanthoplasty.