OBJECTIVE EVALUATION OF THE EYELIDS AND EYEBROWS AFTER BLEPHAROPLASTY

Purpose: Surgery of the upper and lower eyelids and eyebrows is primar ily designed to enhance the esthetic appearance and provide functional visual field benefits. Paramount to successful surgical results is a carefully executed examination and treatment plan. The preoperative an d postoperative evaluation of these individuals has been primarily sub jective. This article describes a method for the quantification of per iorbital relationships that is of use in the preoperative planning and postoperative evaluation of patients undergoing esthetic surgery of t he eyelids and eyebrows. Patients and Methods: The photographic record s of 15 female patients who had undergone bilateral upper eyelid surge ry were examined. None of the patients underwent lower eyelid or eyebr ow surgery. Preoperative and postoperative frontal photographs were pr ojected to a standard size, and measurements were made in a standardiz ed fashion. For the comparison of intrapatient and interpatient relati onships, objective anthropometric proportions rather than average meas urements were used. Therefore, standard periorbital relationships were recorded and expressed as anthropometric ratios. Measurements were re corded for 30 eyes. The preoperative and postoperative relationships w ere measured and reported as mean values with standard deviation. The relationships studied were: 1) Upper lid height to orbit height, 2) Lo wer lid height to orbit height, 3) Lid sulcus height to orbit height, 4) Lid sulcus height to upper lid height, 5) Upper iris coverage to ir is height, 6) Lower iris coverage to iris height, 7) Orbit height to m iddle facial height, 8) Medial brow to orbit height, 9) Lateral brow t o orbit height, and 10) Eye fissure height to orbit height. Brow heigh ts were measured vertically from a line connecting exocanthion and end ocanthion. Results: The postoperative changes in these patients showed the following: Upper lid height, eye fissure height, and brow positio n were not significantly affected by upper lid blepharoplasty surgery. The sulcus lid height was doubled postoperatively, and upper iris cov erage was decreased slightly postoperatively. Conclusions: The results of the study indicate that the proposed methodology is appropriate fo r the objective evaluation of periorbital relationships pertinent to e sthetic periorbital surgery. Its use is suggested as a diagnostic aid in preoperative planning and postsurgical evaluation.