title: Blepharoplasty in senile blepharoptosis: preoperative measurements and design for skin excision.
abstract: BACKGROUND
  For patients with senile ptosis, aesthetic blepharoplasty can be combined with ptosis surgery. However, the amount of skin excision necessary in blepharoplasty is not clearly defined by measurements of the upper eyelids.
  
  
  OBJECTIVE
  The authors preoperatively evaluate the amount of skin to be excised in blepharoplasty.
  
  
  METHODS
  Fifty patients with bilateral senile ptosis were included in this study. The amount of skin to be excised from the upper eyelids was selected based on preoperative measurements of redundant skin, equivalent to the maximum lid height (MLH) while manually stretching the eyelid upwards minus resting lid height (RLH) with the eyes closed passively. Ptosis surgery (such as plication of the aponeurosis) followed blepharoplasty.
  
  
  RESULTS
  Preoperatively, mean MLH was 35 mm on the right and 36 mm on the left. Mean RLH was 25 mm bilaterally. The mean amount (height) of excised skin was 10 mm on the right and 11 mm on the left. At six months postoperatively, mean MLH and RLH were 29 and 23 mm on both sides, respectively. Significant differences between pre- and postoperative MLH and RDH were seen on both sides (P<.001). No complications due to overexcision were observed, but revision was performed for two patients with asymmetry of the lid folds and five patients with recurrence of drooping.
  
  
  CONCLUSIONS
  Preoperative measurements of upper eyelid heights (stretched and at rest) appear useful in determining the amount of skin excision required in blepharoplasty for senile ptosis.
  
  
  METHODS
  4.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan. maegawaj@med.yokohama-cu.ac.jp
authors.forename: Jiro
authors.initials: J
authors.lastname: Maegawa
authors.forename: Shinji
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yabuki
authors.forename: Kouichi
authors.initials: K
authors.lastname: Hirotomi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yasumura
authors.forename: Toshinori
authors.initials: T
authors.lastname: Iwai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D062109:Dermatologic Surgical Procedures; D005143:Eyelids / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged