Purpose:
Upper blepharoplasty requires meticulous surgical planning to achieve a desirable outcome. The upper eyelid crease distance is measured by the distance from the lid crease to the lid margin over the central upper eyelid on down gaze. The upper eyelid crease is relatively narrow in Eastern Asian population, usually 6-8 mm in width, and it is the most emphasized part when performing upper blepharoplasty in patients with blepharoptosis. Our goal is to refine the pre-operative eyelid measurement by comparing the discrepancies between the traditional draping method and the precision marking technique in upper blepharoplasty.
Materials and Methods:
Between December 2018 and April 2019, we conducted a comparative study between the traditional draping and refined precision marking in all patients who received upper blepharoplasty. The procedures were completed by Professor Lai. The data of the eyelid skin redundancy of each test were recorded. The discrepancies between the two measurements were computed for statistical analysis. By performing the push-down and pinch test, the upper eyelid crease line is marked first as the lower incision line, usually along the position of the upper border of the tarsus. The amount of redundant skin to be resected is marked as the upper incision line, which is usually measured with the traditional draping. When performing upper blepharoplasty, releasing the pull-back tension of the forehead caused during head-draping is the key step to maintaining the natural skin appearance.
Results:
We have included 41 patients with blepharoptosis in this study. All patients have undergone bilateral upper blepharoplasty, in other words, a total of 82 eyelids were recorded and analyzed. 44 eyelids of 22 patients have concurrent blepharoptosis. The eyelid skin redundancy measured by the traditional draping was 5.61±1.55mm, and that by the precision marking was 9.11±2.31mm (p < 0.00001). The discrepancy between these two methods varied from 20 to 100%, with an average value of 60.42% (p < 0.00001).
Conclusion:
The result suggests that the precision marking for upper blepharoplasty has provided a superior post-operative outcome by optimizing the double-eyelid effect as was desired by the Eastern Asian patients. The traditional draping was shown to result in under-measurement of eyelid skin redundancy. The measurement and the corresponding extent of resection during upper blepharoplasty is directly linked to post-operative results. In upper blepharoplasty, the refined eyelid precision marking with push-down and pinch test restores the natural eyelid appearance of the patients thereby maximizing the desirable treatment outcome.

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