Muscle-conjunctival Resection Research Articles

Comparative Study between Muller Muscle Conjunctival Resection versus Conventional Ptosis Surgery in Mild to Moderate Ptosis

Comparative Study between Muller Muscle Conjunctival Resection versus Conventional Ptosis Surgery in Mild to Moderate Ptosis

Müller muscle-Conjunctival Resection (MMCR) Surgery: A Comprehensive Literature Review.

This literature review aims to provide a comprehensive overview of the current understanding, indications, techniques, outcomes, and complications of Müller muscle-conjunctival resection (MMCR) surgery. It also addresses areas of debate with MMCR such as predictability concerning Phenylephrine response as well as the amount of muscle resection required. This literature review was compiled based on the available evidence from PubMed from 1975 to August 2023. The success rate of MMCR ranges from 72% to 95%, with high patient satisfaction reported in most studies. The exact range of eyelid elevation after MMCR is variable, with a reported average of 2.1 mm MRD1 elevation. MMCR is a well-established surgical technique used to correct upper eyelid ptosis that results from dysfunction or attenuation of the levator aponeurosis. MMCR proved to be a safe and effective procedure with a high patient satisfaction rate and low risk of complications.

Eyelid and Brow Rejuvenation: Technical Pearls and Outcomes of Upper Blepharoplasty with or without Ptosis Correction and Browlift.

Eyelid ptosis may present with upper lid dermatochalasis and brow ptosis. When indicated, ptosis correction (PC) is advocated during upper blepharoplasty (UB). Here, we aimed to report our outcomes following UB and PC. A retrospective review of patients that underwent UB from November 2018 to March 2020 was performed. Patient demographics, clinical characteristics, and revisions were recorded. Cox regression was performed to assess predictors of revision. Overall, 278 patients with 533 UB were included. Mean age was 67.3 years. Mean follow-up was 8.3 months. In 169 (31.7%) cases, a browlift was performed. UB and PC were performed in 109 (20.5%) cases, of which 60 (55%) involved Müller's muscle conjunctival resection, and 49 (45%) were levator repairs. New dry eye symptoms lasting ≥3 months occurred in 4 (0.8%) cases, all of which resolved. Revision rate was 3.8% after UB (residual skin [n=11], hypertrophic scar [n=4], Herring's law-related ptosis [n=1]); versus 9.2% after UB and PC (overcorrection [n=4], residual skin [n=4], asymmetry [n=2]). Multivariable analysis demonstrated increased revision rates after UB and PC (p-value=0.008). There was no difference in revision rates between different techniques of PC. In our study of 278 patients presenting for dermatochalasis, up to 21% of cases required ptosis correction in addition to upper blepharoplasty. Ptosis correction is a safe procedure when combined with upper blepharoplasty, regardless of technique used. The revision rate in our series was 9.2% after the combined procedure, which is greater than the revision rate of upper blepharoplasty only, however, comparable to the literature.

Hemorrhage Following Muller's Muscle Conjunctival Resection: Description and Case-Control Study.

The purpose of this study was to report a series of patients with postoperative hemorrhage after Muller's muscle conjunctival resection surgery and compare risk factors and outcomes with a control population. In this case-control study, records of patients who underwent Muller's muscle conjunctival resection over 5 years were reviewed for a history of postoperative hemorrhage occurring >24 hours after surgery. A 4:1 control population was matched for age and sex. Clinical data collected included demographics, medical history, medications, and subsequent surgery. Preoperative and 3-month postoperative marginal reflex distance 1 were measured digitally using ImageJ. The hemorrhage and control groups were compared using Fisher's exact tests for categorical variables and independent samples t tests for continuous variables. The hemorrhage group contained 10 patients (mean age 66.4 ± 18.5 years). The control group consisted of 40 age and sex-matched controls. Of 350 charts reviewed, there were 10 cases of postoperative hemorrhage (incidence 2.9%). Hemorrhage occurred a mean of 4.2 ± 1.3 (range 2-7) days after surgery and lasted for a mean of 29.3 ± 19.1 (range 12-72) hours. In all 10 cases, the bleeding resolved with conservative measures. There was no difference between the hemorrhage and control groups in terms of medical conditions, blood thinners, and surgical revision. Preoperative, postoperative, and change in marginal reflex distance 1 did not differ between the hemorrhage and control groups. Hemorrhage occurs approximately 4-5 days postoperatively in a small percentage of patients undergoing Muller's muscle conjunctival resection surgery. This investigation did not identify any consistent risk factors, and outcomes in this patient population appear no different than controls.

The Long-Term Effect on Dry Eye of Posterior Approach Ptosis Surgery Vs. Upper Eyelid Blepharoplasty

Purpose To examine the long-term effect of combined blepharoplasty and Müller muscle-conjunctival resection (MMCR) compared to an upper blepharoplasty procedure on dry eye syndrome. Methods This is a Prospective comparative case series. Two groups of patients participated in this study: the blepharoplasty group included adult patients that underwent blepharoplasty at least 3 years earlier and the ptosis group consisting of adult patients that underwent MMCR with blepharoplasty at least 3 years earlier. The parameters that were compared for all patients before the procedure, on postoperative day 90, and at the long-term follow-up were: Schirmer-test 2, tear break-up time (TBUT), fluorescein staining, and lissamine green (LG) staining. Results The participants included 25 post-MMCR patients with a mean follow-up of 4.94 ± 0.64 years and 15 post-blepharoplasty patients with a mean follow-up of 4.22 ± 0.32 years. There was a significant increase in the postoperative LG and fluorescein staining scores compared to the preoperative scores in the ptosis group (p < .01 and p < .01, respectively) as well as a decrease in postoperative TBUT compared to the preoperative values (p = .044). Those parameters were not significant in the blepharoplasty group. Conclusions Patients who underwent MMCR, but not those following upper blepharoplasty, showed signs of dry eye compared to the preoperative status after long-term follow-up. Dry eye signs should be examined before MMCR surgery, and patients should be aware of the high risk of developing dry eye and the need for long-term treatment. Surgeons should carefully consider performing MMCR for patients with severe dry eye.

Reply re: "Prevalence and Predictors of Hering's Response in Müller's Muscle-Conjunctival Resection".

Reply re: "Prevalence and Predictors of Hering's Response in Müller's Muscle-Conjunctival Resection".

Re: "Prevalence and Predictors of Hering's Response in Müller's Muscle-conjunctival Resection".

Re: "Prevalence and Predictors of Hering's Response in Müller's Muscle-conjunctival Resection".

Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery.

The authors' aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines. A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed. All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up. Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.

The results of Muller Muscle Conjunctival Resection versus Levator Advancement for mild to moderate ptosis.

Purpose: To compare the surgical outcomes of Muller muscle conjunctival resection (MMCR) and levator advancement (LA) in patients with mild to moderate blepharoptosis. Methods: A retrospective review of patients who underwent surgery for mild to moderate ptosis between 2015 and 2020 was performed. The degree of ptosis was graded based on the amount of upper eyelid drooping: mild ≤ 2 mm and moderate < 4 mm. Surgical success was defined as post-operative marginal reflex distance 1 (MRD1) ≥ 4.0 and ≤ 5.0 mm, and a satisfactory eyelid contour. Results: A total of 82 eyes of 65 patients underwent ptosis repair surgeries. MMCR was performed in 48 eyes and LA in 34 eyes. Under-correction was detected in 8.3% and 11.8% of the patients in MMCR group and LA group respectively. There was no patient with over-correction in the MMCR group postoperatively, 3 patients in the LA group had over-correction (0% vs. 8.8% respectively). The success rate in our study was found to be 91.7% in the MMCR group and 72.2% in the LA group. Conclusions: The MMCR and LA procedures are effective approaches in treating patients with mild to moderate eyelid ptosis in our population. Each procedure had its superiority in selected groups of patients. However, the complication rate and duration of surgery were found to be lower in MMCR group. Abbreviations: LA = Levator Advancement, LF = Levator Function, MMCR = Muller Muscle Conjunctival Resection, MRD 1 = Marginal Reflex Distance.

Results of surgical treatment of ptosis of the upper eyelid by the dosed muscle-conjunctival resection of the upper cartilage

Blepharoptosis is an abnormally low position of the upper eyelid in relation to the eyeball due to its omission. The method of surgical treatment of blepharoptosis depends on the function of the levator.The aim. To analyze the results of surgical treatment of partial blepharoptosis of various etiology by the dosed muscle-conjunctival resection of the upper eyelid cartilage.Material and methods. We operated 78 patients (82 eyes) with blepharoptosis, among them with congenital blepharoptosis – 34 people (36 eyes), with acquired – 44 (46 eyes). The patients’ age was from 6 to 82 years.Inclusion criteria: the function of the upper eyelid levator – more than 5 mm, the width of the palpebral fissure – 3 mm or more.The patients underwent a dosed muscle-conjunctival resection of the upper eyelid cartilage in the period from 2018 to 2021. The follow-up period ranged from 2 months to 2 years.Results. Elimination of blepharoptosis was achieved in all patients. With congenital blepharoptosis, a good result was obtained in 33 people (91.7 %), satisfactory – in three patients (8.3 %), which was associated with the asymmetry of the palpebral fissure, for the correction of which these patients underwent additional intervention. In patients with acquired ptosis of the upper eyelid, a good result was achieved in 91.3 % of cases (42 eyes). One patient underwent repeated surgery due to hypocorrection and asymmetry of the palpebral fissure width after the first surgery.In all patients, the result remained stable throughout the observation period.Conclusion. The use of the method of dosed muscle-conjunctival resection of the upper eyelid cartilage in patients with partial ptosis of the upper eyelid and intact levator function made it possible to obtain a good cosmetic and functional result: with congenital blepharoptosis – in 91.7 % of cases, acquired ptosis of the upper eyelid – in 91.3 % patients.

Predictability of the Phenylephrine Test in Congenital Ptosis: Ten Years of Experience.

To assess the predictability of phenylephrine testing for congenital ptosis and review outcomes of Müller's Muscle-conjunctival resection (MMCR) for congenital ptosis across ten years of follow-up. In this retrospective case series, all patients who underwent MMCR for congenital ptosis at a single institution between 2010 and 2020 were identified. Exclusion criteria included patients who had not undergone preoperative testing with 2.5% phenylephrine in the superior fornix; patients who underwent revision surgery; and patients who had a broken suture in the early postoperative period. Demographics, margin-reflex distance 1 (MRD1) values pre- and postphenylephrine, millimeters of tissue resected intraoperatively, and final postoperative MRD1 were recorded. A total of 28 patients were included; 19 patients received MMCR and 9 patients received a combined MMCR plus tarsectomy. The amount of tissue resected ranged from 5 to 11 mm. There was no significant difference between median postphenylephrine MRD1 and median final postoperative MRD1 in either surgical group. Neither patient age nor levator function was significantly associated with a change in MRD1 in either group. The addition of a tarsectomy had no bearing on the final MRD1 value. MMCR is a viable option for patients with congenital ptosis and moderate levator function with a response to phenylephrine. In these patients, MRD1 after 2.5% phenylephrine testing correlates to the final postoperative MRD1 outcome within 0.5 mm.

Sutureless Conjunctiva-Sparing Posterior Ptosis Repair Surgery: A Novel Technique

Müller muscle-conjunctival resection (MMCR) is a popular posterior/internal surgical approach to cases of mild to moderate blepharoptosis with good levator function. MMCR necessitates the removal of healthy conjunctiva and exposes the cornea to suture material. The goal of this study is to describe a novel sutureless conjunctiva-sparing Müllerectomy (CSM) surgery and demonstrate its long-term efficacy, efficiency, and safety. IRB approved retrospective study of patients undergoing sutureless conjunctiva-sparing posterior ptosis repair surgery. The medical records of 100 patients (171 eyes) who underwent sutureless CSM with a minimum follow-up interval of 6 months were retrospectively reviewed. Photographs were analyzed using ImageJ software. Outcome measures were derived from margin reflex distance 1 (MRD1) and palpebral fissure height (PFH) at various postoperative timepoints. Mean ΔMRD1 and ΔPFH at 6 months were 2.85 ± 0.98 mm and 2.60 ± 1.38 mm, respectively. Symmetry within 1 mm was observed 91% of cases. Sutureless CSM took 4.42 minutes on average compared to 8.45 minutes for traditional MMCR. There were no corneal abrasions or ocular complications. The reoperation rate was 2.3% (1 case of overcorrection and 3 cases of undercorrection) per eye. Sutureless CSM is a promising alternative to traditional MMCR and sutured CSM based on long-term outcomes, symmetry, shorter operative time, and low complication rate. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success: Erratum.

Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success: Erratum.

Müller Muscle-Conjunctival Resection for Treatment of Contralateral Ptosis following Unilateral External Levator Advancement.

One of the main causes of unsatisfactory outcomes after unilateral blepharoptosis surgery is asymmetry of the upper eyelid height, which occurs as a result of a contralateral eyelid droop. Therefore, the authors evaluated the efficacy of Müller muscle-conjunctival resection (MMCR) for the treatment of contralateral ptosis following unilateral external levator advancement (ELA). This study analyzed 26 eyelids of 26 patients with upper eyelid height asymmetry following unilateral ELA who underwent contralateral MMCR retrospectively. The phenylephrine test was performed before ELA and before MMCR. The main outcome measures were symmetry outcomes and clinical outcomes. The mean patient age was 55.81 ± 7.98 years (range, 44 to 70 years); 15 were female (57.7%). The Hering dependency was observed in 13 of the patients (50%) before ELA. An adequate response to phenylephrine was observed before MMCR but not before ELA. Symmetry outcomes after MMCR were perfect (<0.5 mm), good (≥0.5 mm and <1 mm), and fair (≥1 mm) in seven, 17, and two patients, respectively. An optimal upper eyelid height was noted in 47 of the 52 eyelids after the MMCR, whereas three of the 52 eyelids had minimal overcorrection, and two eyelids had undercorrection. The mean change in marginal reflex distance 1 of the contralateral eyelid droop was greater for patients with than without the Hering dependency ( P < 0.0001) after ELA but not after MMCR. Two patients (7.6%) underwent revision ELA surgery. MMCR and use of the phenylephrine test to predict the eyelid position may represent an alternative approach in patients who require management of contralateral ptosis following unilateral ELA. Therapeutic, IV.

Muller's muscle conjunctival resection versus external levator advancement for ptosis repair: systematic review and meta-analysis.

To compare the outcome of Muller's muscle conjunctival resection (MMCR) versus external levator advancement (ELA) in patients undergoing ptosis surgery. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and a search of electronic information was conducted to identify all comparative studies of MMCR versus ELA in ptosis repair. The primary outcome measures were the post-operative marginal reflex distance (MRD1), ptosis under-correction, over-correction, and re-operation rate. Secondary outcome measures included cosmetic appearance, complications, operative time, and learning curve. Fixed-effect modelling was used for the analysis. Seven studies that enrolled 1038 eyelids were identified in the literature. There was no statistically significant difference between the MMCR and ELA groups in post-operative MRD1 (Mean Difference [MD] = 0.13, P = 0.28) and the rate of under-correction odds ratio [OR] = 0.49, P = 0.14). However, ELA had a significantly higher rate of over-correction (OR = 0.17, P = 0.04) and re-operations (OR = 0.26, P = 0.0001) compared to MMCR. For secondary outcomes, MMCR had an improved cosmetic appearance, lower total number of complications and shorter operation time (MD = -10.96, P < 0.00001). Finally, the two techniques had no significant difference in the learning curves. Both MMCR and ELA are effective techniques for the surgical correction of ptosis; however, MMCR surgery is a more predictable and robust technique compared to, ELA with lower rates of over-correction and re-operation.

Optimizing Management of Asymmetric Ptosis: A Comparison of Three Posterior Approach Resection Algorithms.

The purpose of this study was to compare the efficacy of 3 resection algorithms in the management of patients with asymmetric ptosis. Patients undergoing bilateral Muller's muscle-conjunctival resection (MMCR) were identified. Standardized preoperative clinical photographs were examined and margin reflex distance 1 (MRD1) was measured using ImageJ. Patients presenting with ≥1 mm of asymmetry in MRD1 were included. Three groups were identified: variable (4:1 ratio, with the lower side receiving a greater resection), fixed (7 mm resection bilaterally), and tarsectomy (7 mm bilaterally + 1 mm of tarsus resected on the lower preoperative side). Postoperative MRD1 was measured from photographs obtained 3 months after surgery. The primary outcome was postoperative asymmetry. A total of 95 patients with a mean age of 71.0 ± 11.0 years were included. There was no significant difference in age ( p = 0.277) or length of follow-up ( p = 0.782) between the groups. Although the fixed tarsectomy group had significantly greater preoperative asymmetry ( p = 0.001), there was no significant difference in postoperative asymmetry ( p = 0.166). On multivariate analysis, preoperative asymmetry was the only significant predictor of postoperative asymmetry ( p < 0.001). Specifically, the surgical group was not a predictor of the primary outcome ( p = 0.723). Resection amount and technique did not predict postoperative outcomes in cases of asymmetric ptosis. This may support the hypothesis that changes in eyelid position and symmetry following MMCR is due to a dynamic system, rather than as a result of purely mechanical forces.

Efficacy of Müller's Muscle-conjunctival Resection With or Without Suturing for the Correction of Ptosis.

The purpose of this study was to compare the efficacy of Müller muscle-conjunctival resection (MMCR) with or without suturing for the correction of ptosis. A retrospective chart review was performed of 30 patients (56 eyelids) undergoing sutureless (sMMCR) (34 eyelids) or conventional MMCR (cMMCR) (22 eyelids). Primary outcome measures were the change in MRD1 and vertical eyelid height (VLH). Secondary outcome measures were the amount of resection of MMCR (rMMCR) and postoperative symmetry of 1 mm or less. In total, 49 eyelids (87.5%) had involutional ptosis and 7 (12.5%) had contactlens induced ptosis. The age and follow up between the sMMCR and cMMCR groups was, respectively, 65.1 ± 11.0 versus 65.5 ± 11.0 years and 4.0 ± 2.5 versus 6.5 ± 2.1 months. Preoperatively there were no significant differences noted between the sMMCR and cMMCR groups. Postoperatively there was a statistically significant difference in change of MRD1 between the sMMCR and cMMCR groups, 2.74 ± 0.20 mm and 2.02 ± 0.25 mm ( p = 0.026). The difference in change of VLH and rMMCR was not significant between the sMMCR and cMMCR groups, 2.28 ± 0.13 mm and 2.14 ± 0.15 mm ( p = 0.49) and 9.29 ± 2.14 versus 9.46 ± 1.97 mm ( p = 0.83). There were no significant differences in postoperative symmetry. The sMMCR and cMMCR techniques demonstrated equal effectiveness for the correction of ptosis. The rapid sMMCR could become the procedure of choice for the correction of involutional and contact lens induced ptosis.

Effect of Muller's muscle-conjunctival resection on the upper eyelid crease position in Asian eyelids: a retrospective cohort study

PurposeInvestigating the effect of Muller’s muscle-conjunctival resection (MMCR) on the eyelid crease position.MethodsThis retrospective study included patients with unilateral acquired blepharoptosis who underwent MMCR during October 2018–December 2021. The following factors were recorded: preoperative, after phenylephrine, postoperative marginal reflex distance1 (MRD1) and tarsal platform show (TPS) of bilateral eyelids. The primary outcome was to measure the change in TPS and evaluate the factors associated with post-operative TPS. The secondary outcomes included exploring the rate of MRD1 and TPS symmetry after the operation.ResultsForty patients were included in the final analysis. The mean MRD1 of the ptotic eye was 1.28 ± 0.78 mm, 2.79 ± 0.66 mm and 3.20 ± 0.67 mm before, after phenylephrine and after the operation, respectively. The mean TPS of the ptotic eye was 5.90 ± 1.86 mm, 3.96 ± 1.49 mm and 2.79 ± 1.63 mm before, after phenylephrine and after the operation, respectively. Changes in mean TPS after the phenylephrine test and post-operation were statistically significant (p < 0.001). The linear regression model revealed that the absolute change in TPS after phenylephrine drop and absolute change in MRD1 post-operation were significantly correlated with the absolute change in TPS post-operation. Besides, the ratio of symmetry in MRD1 and TPS was greatly improved post-operation (82.5% and 70.0% respectively).ConclusionMMCR is an effective surgical method for ptosis correction as it can not only correct the eyelid crease position but also narrow the wide TPS. This method is particularly beneficial to patients with both mild to moderate ptosis and an asymmetric crease height.

Revision ptosis surgery for under-correction after Müller muscle conjunctival resection

Müller muscle conjunctival resection (MMCR) may be more likely to lead to under- rather than over-correction. The choice of revision surgery is not clearly defined. MMCR patients were included if the post-operated eyelid(s) demonstrated margin reflex distance-1 (MRD1) less than 3.5mm, or if MRD1 asymmetry was greater than 0.5mm, and if they underwent subsequent revision surgery. MRD1 was the primary outcome measure and complications were secondary outcome measures. Two groups were defined: patients who underwent MMCR then repeat MMCR (M-M) and those who underwent MMCR followed by external levator resection (ELR) surgery (M-L). 18 eyelids (16 patients) were included, 12 in M-M and 6 in M-L. Mean (SD) preoperative MRD1 was 1.84mm (0.97), range -0.41 to 3.39mm. There was no difference (p=0.70) in preoperative MRD1 between M-M and M-L. In the M-M group, mean (SD) MRD1 was 1.77mm (1.12) preoperatively, 2.35mm (0.66) after the first surgery, and 3.44mm (0.31) after revision. Mean MRD1 was significantly higher after revision, compared to preoperatively (p<0.05) and after first surgery (p<0.05). In the M-L group (n=6), mean (SD) MRD1 was 1.98mm (0.90) preoperatively, 1.99mm (0.56) after the first surgery and 3.44mm (1.24) after revision. The difference between preoperative and post revision surgery MRD1 was significant (p<0.05). For patients with insufficient elevation of MRD1 or with asymmetry after MMCR, revision by MMCR or by ELR are both reasonable options.

P11. UPPER BLEPHAROPLASTY WITH OR WITHOUT PTOSIS CORRECTION: AN ANALYSIS OF OUTCOMES IN 533 CONSECUTIVE PROCEDURES AT AN ACADEMIC HOSPITAL

PURPOSE: Eyelid ptosis may present along with upper lid dermatochalasis and brow ptosis. When indicated, ptosis correction (PC) is advocated during upper blepharoplasty (UB). In this study, we aimed to report outcomes following UB with PC. METHODS: A retrospective review of consecutive patients that underwent UB from November 2018 to March 2020 was performed. Patient demographics, clinical characteristics as well as revisions were recorded. Cox-regression was performed to assess predictors of revision surgery. RESULTS: Overall, 278 patients with 533 primary UB were included. The mean age was 67.3 years and mean follow-up was 8.3 months. In 169 (31.7%) cases, a brow lift was performed. UB with PC was performed in 109 (20.5%), of which 60 (55%) involved Müller’s muscle conjunctival resection and 49 (45%) were levator repairs. There were no wound complications. New dry eye symptoms lasting ≥3 months occurred in 4 (0.8%) cases all of which resolved. A revision was performed in 3.8% after UB alone (residual skin [n=11], hypertrophic scar [n=4], Herring’s law related ptosis [n=1]); versus 9.2% in the UB with PC group (overcorrection [n=4], residual skin [n=4], asymmetry [n=2]). The multivariable analysis demonstrated increased rate of revision when UB was combined with PC (adjusted HR: 4, 95% CI [1.8-8.8], p= 0.008). There was no difference in revision rates between the different techniques of ptosis correction. CONCLUSION: Upper blepharoplasty with PC is safe regardless of which PC technique is used. The revision rate of combined UB and PC was 9.2%, which is comparable to the literature.