title: Objective Outcome Measurement After Upper Blepharoplasty: An Analysis of Different Operative Techniques.
abstract: BACKGROUND
  Upper blepharoplasty is indicated in Asians for double-eyelid fold creation, periorbital rejuvenation, and functional visual field improvement. This article introduces a technical classification for blepharoplasty methods and investigates approaches to evaluate its outcomes.
  
  
  METHODS
  Of 535 patients undergoing aesthetic upper blepharoplasty in our institution in 1998-2011, 136 patients who were well followed up were retrospectively reviewed and categorized into four groups according to the techniques employed. Blepharoplasty with skin excision only was indicated for upper eyelid-skin redundancy patients with prominent double eyelids (n = 20). Blepharoplasty with skin excision and nonburied suture fixation was indicated for patients with upper lid-skin redundancy and weak double eyelids (n = 15). Blepharoplasty with skin excision and buried suture fixation was indicated for patients with upper lid-skin redundancy but no double-eyelid folds (n = 46). Finally, blepharoplasty with simultaneous ptosis correction was utilized for patients with senile or subclinical ptosis requesting upper blepharoplasty (n = 55). The mean age was 48.7 years at surgery; the mean follow-up period was 6 months. Digital photographs were used to compare changes in marginal reflex distance 1 (MRD1), percentage of the area of corneal exposure (%ACE), and brow height.
  
  
  RESULTS
  MRD1increased from 1.92 to 2.84 mm in the whole patient group after upper blepharoplasty; it increased the most in blepharoplasty with simultaneous ptosis correction (1.22 mm). %ACE increased from 62.1 to 76.6% (14.5%), whereas brow height decreased from 29.4 to 26.7 mm (9.2%).
  
  
  CONCLUSIONS
  Upper blepharoplasty improves palpebral fissure. Numerically measured palpebral fissure changes facilitate operation outcome measurement.
  
  
  METHODS
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authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Daegu Catholic University Medical Center, 33, Duryugongwon-Ro 17-Gil, Nam-Gu, Daegu, Korea.
authors.forename: Ki-Soo
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Plastic and Reconstructive Surgery, College of Medicine, Daegu Catholic University Medical Center, 33, Duryugongwon-Ro 17-Gil, Nam-Gu, Daegu, Korea. dhpark@cu.ac.kr.
authors.forename: David Dae-Hwan
authors.initials: DD
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000235:genetics*; D019882:Blepharoplasty / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D004954:Esthetics; D005143:Eyelids / Q000002:abnormalities / Q000601:surgery*; D005149:Facial Expression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D056910:Republic of Korea; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Aesthetic surgery; Blepharoplasty; Surgical techniques