Preoperative asymmetry is a risk factor for reoperation in involutional blepharoptosis

Summary Background Patients with involutional blepharoptosis sometimes require reoperation because of functional or esthetic reasons after the primary operation. Few studies have analyzed the risk factors for reoperation in such cases. Methods We retrospectively analyzed the cases of 274 patients who underwent levator aponeurosis surgery for bilateral involutional blepharoptosis. We examined the risk factors for reoperation using univariate and multivariate analyses. Results Reoperation was performed for 89 of the 274 patients (32.5%). There was no significant difference in the rate of reoperation among surgeons. In the univariate analysis, patients with preoperative asymmetry, defined as a difference of >1 mm in the marginal reflex distance between the right and left sides, showed a significantly higher rate of reoperation (42.7%) than those without asymmetry (28.1%) ( p  = 0.018). Age, sex, and ptosis severity did not affect the rate of reoperation. The multivariate analysis with a logistic regression showed that preoperative asymmetry was a significant risk factor for reoperation, with an odds ratio of 1.90 ( p  = 0.019). Conclusion In involutional blepharoptosis, patients with preoperative asymmetry should be informed of the higher risk of reoperation, and the balance between the right and left sides should be carefully adjusted intraoperatively.