title: Preoperative asymmetry is a risk factor for reoperation in involutional blepharoptosis.
abstract: BACKGROUND
  Patients with involutional blepharoptosis sometimes require reoperation because of functional or esthetic reasons after the primary operation. Few studies have analyzed the risk factors for reoperation in such cases.
  
  
  METHODS
  We retrospectively analyzed the cases of 274 patients who underwent levator aponeurosis surgery for bilateral involutional blepharoptosis. We examined the risk factors for reoperation using univariate and multivariate analyses.
  
  
  RESULTS
  Reoperation was performed for 89 of the 274 patients (32.5%). There was no significant difference in the rate of reoperation among surgeons. In the univariate analysis, patients with preoperative asymmetry, defined as a difference of >1 mm in the marginal reflex distance between the right and left sides, showed a significantly higher rate of reoperation (42.7%) than those without asymmetry (28.1%) (p = 0.018). Age, sex, and ptosis severity did not affect the rate of reoperation. The multivariate analysis with a logistic regression showed that preoperative asymmetry was a significant risk factor for reoperation, with an odds ratio of 1.90 (p = 0.019).
  
  
  CONCLUSIONS
  In involutional blepharoptosis, patients with preoperative asymmetry should be informed of the higher risk of reoperation, and the balance between the right and left sides should be carefully adjusted intraoperatively.
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan. Electronic address: sugah-tky@umin.ac.jp.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Suga
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Mine
authors.initials: M
authors.lastname: Ozaki
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Keigo
authors.initials: K
authors.lastname: Narita
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shiraishi
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takushima
authors.affiliation: Department of Plastic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Harii
mesh_terms: D000367:Age Factors; D000368:Aged; D001763:Blepharoptosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors
keywords: Blepharoptosis; Preoperative asymmetry; Reoperation; Risk factor