title: The Effect of Transconjunctival Blepharoplasty on Margin Reflex Distance 2.
abstract: BACKGROUND
  The objective of this study was to determine the effects of lower eyelid transconjunctival blepharoplasty (TCB) on lower eyelid position.
  
  
  METHODS
  Transconjunctival blepharoplasty was performed alone in 15 lower eyelids without simultaneous canthoplasty or upper eyelid procedure. In this study, blepharoplasty was performed by the transconjunctival approach without removal of skin. Four eyes received TCB plus Erbium laser, two patients received TCB plus trichloroacetic acid peel (TCA), and three patients received TCB plus fat transposition. Pre-operative and post-operative margin reflex distance 1 (MRD 1) and margin reflex distance 2 (MRD 2) were compared, with MRD 1 acting as the control.
  
  
  RESULTS
  Average time to post-operative photo was 4.6 months (1-10 months). The changes in MRD 2 and MRD 1 were compared pre- and post-operatively, and the difference reached significance by one-tailed comparison (P < 0.05). In 11/15 eyes (73 %), MRD 2 decreased post-operatively. In 6/7 eyes (86 %), lower lid scleral show was eliminated post-operatively. There were no cases of lid retraction noted.
  
  
  CONCLUSIONS
  Transconjunctival blepharoplasty (± skin resurfacing) did not induce lid retraction but elevated the lower lid in majority of patients. Elevation of the lower lid can reduce or eliminate scleral show inferiorly, providing further cosmetic advantage. The presumed mechanism of lower lid height elevation is partial recession of the lower lid retractors during the surgical approach to the fat pockets.
  
  
  METHODS
  This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, 11th and 12th Floors, New York, NY, 10021, USA.
authors.forename: Kira L
authors.initials: KL
authors.lastname: Segal
authors.affiliation: Department of Ophthalmology, NYU Langone Medical Center, Institute of Reconstructive Plastic Surgery, 240 East 38th Street, 13th Floor, New York, NY, 10016, USA.
authors.forename: Payal
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, 11th and 12th Floors, New York, NY, 10021, USA.
authors.forename: Ben
authors.initials: B
authors.lastname: Levine
authors.affiliation: Department of Ophthalmology, NYU Langone Medical Center, Institute of Reconstructive Plastic Surgery, 635 Park Avenue, New York, NY, 10021, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lisman
authors.affiliation: Department of Ophthalmology, NewYork-Presbyterian/Weill Cornell Medical Center, 11th and 12th Floors, New York, NY, 10021, USA. gjl9003@med.cornell.edu.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Lelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000379:methods*; D003228:Conjunctiva; D003357:Cosmetic Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Blepharoplasty; Eyelid rejuvenation; Laser resurfacing