Aesthetic Changes of Brow-Eyelid Continuum After Correction of Moderate-Severe Blepharoptosis with Conjoint Fascial Sheath Suspension

The Aesthetic Evaluation of the Brow-Eye Continuum After Correction of Severe Congenital Ptosis in Children With Extended Frontalis Muscle Advancement Technique

BACKGROUND

Severe congenital ptosis is a common ocular deformity in pediatric patients that can significantly impact visual development and aesthetic appearance, leading to negative psychosocial outcomes. The frontalis muscle advancement technique is a well-established surgical treatment for severe congenital ptosis. Aesthetic changes of the brow-eye continuum often plays an important role in ptosis surgery.

METHODS

We conducted a single-center retrospective case series study of patients with severe congenital ptosis who underwent the frontalis muscle advancement technique at the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University between April 2020 and June 2021. The study aimed to evaluate the aesthetic changes of the eyebrow-eyelid continuum after surgery. The main outcome measurements included marginal reflex distance 1, palpebral fissure height, eyebrow position, upper eyelid to lower eyebrow distance, lower eyelid to upper eyebrow distance, and nasal base to lower eyelid distance.

RESULTS

The study included 48 patients (66 eyelids), with 30 unilateral and 18 bilateral patients. Our analysis found that eyebrow height decreased by an average of 4.8% postoperatively relative to preoperatively in all patients.

CONCLUSIONS

The frontalis muscle advancement technique has demonstrated effectiveness in achieving aesthetically pleasing outcomes in children with severe ptosis. It is crucial to pay careful attention to the brow-eye continuum during the correction process, as its harmony can greatly impact the final result.

Brow Position Change and its Potential Risk Factors Following Upper Blepharoplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Eyebrow position affects human facial expression and aesthetic appearance. However, upper-eyelid surgeries may cause brow position changes and affect the function and aesthetics of the eyebrow. The purpose of this review was to assess the influence of upper-eyelid surgeries on brow position and morphology.

METHODS

PubMed, Web of Science, Cochrane Library, and EMBASE were searched for clinical trials and observational studies published between 1992 and 2022. The brow height from the center of the pupil is analyzed to show the brow height change. The change in brow morphology is measured by the change in brow height from the lateral palpebral and the medial palpebral. Studies are further divided into subgroups according to different surgical techniques, author locations, and whether to conduct skin excision.

RESULTS

Seventeen studies met the inclusion criteria. Nine studies and 13 groups were included in the meta-analysis, indicating that brow height decreased significantly after upper-eyelid surgeries (MD = 1.45, 95% CI [0.87, 2.07], P < 0.0001), and simple blepharoplasty, double-eyelid surgery, and ptosis correction can cause the brow position to drop by 0.67, 2.52, and 2.10 mm, respectively. East Asian authors group had a significant decrease in brow height compared with the non-East Asian authors group (28 groups, p = 0.001). Skin excision during blepharoplasty does not affect brow height.

CONCLUSIONS

Brow position changes significantly following upper blepharoplasty according to the decrease in brow-pupil distance. The morphology of the brow showed no significant postoperative change. Different techniques and authors locations may result in different levels of postoperative brow descent.

LEVEL OF EVIDENCE III

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