Eyelid bags and blepharochalasis are the result of relaxation of lid structures like the skin, the orbicularis oculi, and mainly the orbital septum. Therefore, this aged appearance cannot be improved sufficiently with only a skin and orbicularis oculi resection. To improve this appearance, we use a very effective method of tucking of the orbital septum with infraeyebrow excision of the skin and the orbicularis oculi. Between January 2005 and April 2011, 103 patients (206 lids) were treated. There were 89 female and 14 male patients whose ages ranged from 43 to 75 years (mean = 65.2 years). After infraeyebrow excision, blepharoplasty with tucking of the orbital septum, the concealed lid crease becomes apparent and a good rejuvenation effect is obtained in all patients.
Common early signs of aging in the upper eyelid include baggy appearance, blepharochalasis, and lateral drooping of the skin. These changes give the appearance of older eyes and are often associated with limitation of upper lateral visual fields. These aesthetic and functional complaints contribute to a patient’s perception of the need for upper lid blepharoplasty. Infraeyebrow blepharoplasty has become widely accepted and performed in East Asia [
Between January 2005 and April 2011, 103 patients (206 lids) were treated. There were 89 female and 14 male patients whose ages ranged from 43 to 75 years (mean = 65.2 years). The primary indication for our infraeyebrow blepharoplasty included patients who complained of aesthetic discontent and superior visual field limitation with blepharochalasis, but who did not have obvious levator muscle dysfunction. We indicated the operative procedure to patients whose levator function was better than 8 mm. They were followed up after 3 months to 6 years (mean = 10.6 months) (Table
Characteristics of patients (
Number | Range (mean) | |
---|---|---|
Sex | ||
Female | 89 | |
Male | 14 | |
Age | 43–75 (65.2) | |
Follow-up period (months) | 3–84 (10.6) |
Before the operation, we make a rough estimate to decide the quantity of skin to be resected by pinching the surplus skin with forceps in the infraeyebrow area while patients are in the sitting position.
In our operative design, an upper excision line is drawn following the lower edge of the eyebrow from 2-3 mm lateral to the medial angle of the eye to the lateral end of the eyebrow. At the end point of the eyebrow, the excision line is extended upwards approximately 10–15 mm at an angle of 30°. The lower excision line begins from the same point as the upper line and increases in width laterally to the lateral two-thirds point of the eyebrow, thus creating a spindle shape. The lower line then extends almost parallel with the upper line to the axis through the end point of the eyebrow. At the cross-point of the lower excision line and the axis through the end point of the eyebrow, the lower excision line extends directly to the end point of the upper excision line (Figure
Design of the skin excision. (a) At the end point of the eyebrow, the excision line is extended straight up at an angle of 30°. (b) The greatest width is at the lateral two-thirds point of the eyebrow.
In our operative procedure, we excise the skin and subcutaneous fat tissue totally from the surface of the orbicularis oculi muscle. After excision of the skin and fat tissue, we also excise the orbicularis oculi 1-2 mm inside the skin excision line and the preseptal fat tissue in the same area if it is distensible. Once this step is completed, the orbital septum is identified. The orbital septum is caught with forceps in this condition, and it should be pulled gently to confirm that it pulls the tarsal plate together. After confirmation of the orbital septum, the orbicularis oculi is sutured end to end with plication of the orbital septum using 5/0 nylon thread (Figure
Tucking of the orbital septum.
At the time of writing, the lateral drooping of the lid skin is improved and the lid crease becomes more clearly defined (Figures
A 45-year-old woman. (a) Preoperative view, the greatest width of excised skin was 7 mm. (b) Six months after the operation.
A 61-year-old woman. (a) Preoperative view, the greatest width of excised skin was 8 mm. (b) One year after the operation.
A 62-year-old woman. (a) Preoperative view, the greatest width of excised skin was 7 mm. (b) Seven months after the operation.
The most remarkable signs of the aging upper eyelid are drooping of anatomical structures like the skin, the orbicularis oculi muscle, and the orbital septum. Although upper eyelid skin thickness is not markedly affected by aging [
Most upper eyelid blepharoplasty operations are performed through an incision into the lid crease (or low area in the upper lid) [
There are various operative designs in infraeyebrow blepharoplasty, and these depend on the surgeon undertaking the procedure. Hara et al. [
Most of the reported cases of infraeyebrow blepharoplasty have only considered skin resection in the infraeyebrow area [
The only aesthetic disadvantage of this approach is a slight brow flattening and shortening of the brow and ciliary distance [
Although our operative technique is useful in East Asian subjects, the indications of this technique in Caucasian subjects should be considered carefully [
Patients provided written consent for the use of their images.
The author reports no conflict of interests in this work.