Upper Eyelid Blepharoplasty: Comparison of Surgical Designs and Outcomes Between East Asian and Northern European Patients.

BACKGROUND: Blepharoplasty treats dermatochalasis. Surgical modifications in blepharoplasty for East Asians exist. However, studies that compare the intraoperative design and outcomes between East Asian and Northern European patients are limited. PURPOSE: The purpose of this study is to compare the intraoperative ocular soft tissue designs including lid crease position (LCP, measured from upper eyelid crease to the lid margin), the width of the skin resected, and the postsurgical outcomes between the 2 groups. STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study of East Asian and Northern European patients with diagnosis of dermatochalasis, who underwent blepharoplasty at Emory University Hospital between 2011 and 2021. Patients with ptosis or prior surgeries were excluded. PREDICTOR VARIABLE: The predictor variable is race (Northern European or East Asian). OUTCOME VARIABLES: The main outcome variable was intraoperative soft tissue design measured using LCP and the width of the skin resected. The secondary outcome variable was the postoperative change in the amount of blepharoptosis measured by changes in margin reflex distance (MRD-1). COVARIATES: Covariant is gender (self-defined male or female). ANALYSES: A t-test was conducted. P < .05 was statistically significant. RESULTS: The sample was composed of 642 subjects with a mean age of 66.8 (SD = 9.1), 195 (30.4%) were male, and 54 (8.4%) were East Asian. The LCP was 6.7 mm (SD = 1.6) for the East Asians and 9.9 mm (SD = 0.5) for the Northern Europeans (P < .05). The width of the skin excised was 4.2 mm (SD = 1.6) for the East Asians and 8.7 mm (SD = 2.0) for the Northern European (P < .05). The MRD-1 change was 1.5 ± 1.1 mm in the East Asians and 1.1 ± 1.1 mm in Northern Europeans (P < .05). CONCLUSIONS AND RELEVANCE: East Asians have different eyelid anatomy; thus, the blepharoplasty design is adjusted to preserve their ethnic natural appearance. This study found that the East Asian group had less LCP, smaller width of the skin excised, and a greater improvement in the MRD-1. This information could be useful for the intraoperative design of East Asian eyelids.