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This is a review of patients undergoing upper lid external levator resection ptosis surgery or blepharoplasty, to assess whether the degree of early postoperative swelling affects the final lid position. Twenty-five patients undergoing ptosis surgery and 29 upper lid blepharoplasty were included. Photographs from the preoperative, early postoperative (one week) and late postoperative (three months) periods were analysed to measure the margin reflex distance (MRD1) and the degree of postoperative lid swelling. Regression analysis showed that the degree of swelling at one week did not affect prediction of the final lid height in the ptosis group, but did in the blepharoplasty group, i.e., blepharoplasty patients were more likely to have a temporary reduction in MRD1 due to swelling postoperatively than ptosis patients. Unfortunately, the study provides no data on the actual degree of lid swelling in either group, although they did find that a lower MRD1 preoperatively was associated with greater swelling, which the authors suggest may be due to more extensive dissection to correct the greater ptosis. The study also includes bilateral surgical cases with random selection of one eye, which adds another potential variable due to Hering’s law. The findings in regard to ptosis surgery are surprising as intuitively one would expect significant postoperative swelling to temporarily reduce the MRD1. If the findings are verified by a larger study then they would be a useful guide to advising patients in the early postoperative period.

The effect of early post-operative swelling on change in upper eyelid position after external levator resection and blepharoplasty.
Cohen LM, Katsev B, Esfandiari M, Rootman DB.
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