The Effect of Early Postoperative Swelling on Change in Upper Eyelid Position After External Levator Resection and Blepharoplasty

Purpose: To determine if early postoperative swelling has an effect on change in the upper eyelid position after external levator resection (ELR) or blepharoplasty. Methods: In this observational cohort study, patients >18 years old who underwent ELR or upper blepharoplasty were identified. Digital photographs in primary position were obtained at the preoperative, early postoperative week one, and late postoperative month 3 visits. Marginal reflex distance 1 (MRD1) was measured digitally. Swelling was graded on a previously validated scale from 0 to 3. Photographs were evaluated by 26 experts/professional image graders. Primary outcome measure was changed in MRD1 from preoperative to late postoperative visits. Secondary outcome measure was change in MRD1 from early to late postoperative visits. The effect of early postoperative swelling on each outcome was assessed using linear regression models. Results: The sample contained 54 patients (25 ELR and 29 blepharoplasty). The model regressing change in MRD1 from preoperative to late postoperative visits with early postoperative swelling as the predictor was significant for ELR (R 2 = 0.165, p = 0.044) but not blepharoplasty (R 2 = 0.016, p = 0.515). However, the model controlling for preoperative MRD1 was not significant for ELR (B = 0.423, p = 0.354). The model regressing change in MRD1 from early to late postoperative follow up utilizing early postoperative swelling as the sole predictor was not significant for ELR (R 2 = 0.010, p = 0.627) but was significant for blepharoplasty (R 2 = 0.207, p = 0.013), with increased swelling associated with greater change in MRD1. Conclusions: Early postoperative swelling does not affect the final MRD1 outcome of ELR or upper blepharoplasty; however, blepharoplasty patients with early postoperative swelling may experience greater increase in MRD1 over follow up.