Swelling After Eyelid Surgery Not A Factor in MRD1 Changes

Patients with blepharoplasty who have more early postoperative swelling can expect a greater increase in MRD1 from early to late postoperative follow up.

Early postoperative swelling after external levator resection (ELR) or upper blepharoplasty doesn’t affect the final marginal reflex distance 1 (MRD1) outcome, according to a publication in Ophthalmic Plastic and Reconstructive Surgery. Blepharoplasty patients with early postoperative swelling may experience a greater increase in MRD1 on follow-up, the researchers behind the study note.

ELR and blepharoplasty are 2 of the most frequently performed upper eyelid surgeries. Successful surgery is typically defined as a change in the upper eyelid position or MRD1. Successful outcomes in blepharoplasty surgery also include a small increase in MRD11–3 and an increase in tarsal platform show. However, postsurgical edema and inflammation after surgery can make observing these outcome milestones more difficult. 

To determine if early postoperative swelling influences change in the upper eyelid position, investigators observed patients older than 18 years who underwent ELR or upper blepharoplasty. Digital photographs in primary position were taken at the preoperative, early-postoperative week one, and late-postoperative month 3 visits. 

The study sample included 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 (R2 = 0.165, P = 0.044) but not blepharoplasty (R2 = 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 using early postoperative swelling as the sole predictor was not significant for ELR (R2 = 0.010, P = 0.627) but was significant for blepharoplasty (R2 = 0.207, P = 0.013), with increased swelling associated with greater change in MRD1, according to researchers.

The study’s authors note a few limitations to their work, including its small sample size, limited follow-up time, and use of average corneal diameter as a reference.

“When faced with the decision of whether to perform early revision surgery, the authors’ results are conflicting for ELR and blepharoplasty. For ELR, swelling should not factor into the decision to perform early reoperation. If the eyelid is low or high, it will be expected to remain stable after swelling resolves, and one should consider early reoperation,” the study’s authors explain. “In contrast, blepharoplasty patients presenting with a low MRD1 and swelling can be simply observed and reassured, as they may experience a greater increase in MRD1 over follow up, though the final outcome is no different.”


Cohen LM, Katsev B, Esfandiari M, et al. The effect of early postoperative swelling on change in upper eyelid position after external levator resection and blepharoplasty. Ophthalmic Plast Reconstr Surg. 2021;37(4):320-323. doi:10.1097/IOP.0000000000001740.