Skin-Only Versus Skin-Plus-Orbicularis Resection Blepharoplasty: An Elaborated Analysis of Early- and Long-Term Effects on Corneal Nerves, Meibomian Glands, Dry Eye Parameters, and Eyebrow Position : Ophthalmic Plastic & Reconstructive Surgery

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Skin-Only Versus Skin-Plus-Orbicularis Resection Blepharoplasty: An Elaborated Analysis of Early- and Long-Term Effects on Corneal Nerves, Meibomian Glands, Dry Eye Parameters, and Eyebrow Position

Dericioğlu, Volkan M.D., F.E.B. OPHT.; Şan, Burçin M.D.; Sevik, Mehmet Orkun M.D.; Akkaya Turhan, Semra M.D., F.E.B.OPHT.

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Ophthalmic Plastic and Reconstructive Surgery 39(5):p 479-486, September/October 2023. | DOI: 10.1097/IOP.0000000000002376

Purpose: 

To evaluate the early- and long-term effects of 2 different blepharoplasty techniques on corneal nerves, meibomian gland morphology, clinical parameters of dry eye disease (DED), and eyebrow position.

Methods: 

This prospective, interventional study included age-sex-matched blepharoplasty patients who had a skin-only resection (24 eyes of 12 patients; Group-S) or a skin-plus-orbicularis muscle resection (24 eyes of 12 patients; Group-M) procedure. Preoperative and postoperative parameters of in vivo corneal confocal microscopy (IVCCM; corneal nerve fiber density [CNFD], nerve branch density [CNBD], and nerve fiber length), meibomian gland area loss (MGAL), DED (Schirmer I test and noninvasive tear breakup time), and eyebrow heights (lateral [LBH] and central [CBH]) were evaluated and compared between the intervention groups (ClinicalTrials.gov, NCT05528016).

Results: 

Compared with baseline, the CNBD of Group-S (19.91 ± 7.66 vs. 16.05 ± 7.28 branches/mm2, p = 0.049) and CNFD of Group-M (19.52 ± 7.45 vs. 16.80 ± 6.95 fibers/mm2, p = 0.028) was significantly decreased at postoperative first week. However, in both groups, IVCCM parameters returned to baseline values at postoperative first month and first year (p > 0.05). A significant MGAL increase was observed in Group-S (18.47 ± 5.43 vs. 19.94 ± 5.31, p = 0.030) and Group-M (18.86 ± 7.06 vs. 20.12 ± 7.01, p = 0.023) at the postoperative first year, demonstrating meibomian gland atrophy. Only significant changes were observed in Group-M in LBH (16.17 ± 2.45 vs. 16.67 ± 2.28 mm, p = 0.044) and CBH (17.33 ± 2.35 vs. 17.96 ± 2.31 mm, p = 0.004) at postoperative first year.

Conclusions: 

Blepharoplasty with or without orbicularis resection seems to have similar effects on IVCCM, DED, and MGAL parameters. However, incorporating an orbicularis muscle resection in a blepharoplasty operation could slightly elevate the eyebrow position.

© 2023 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.

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