Changes in ocular globe-to-orbital rim position with age: Implications foraesthetic blepharoplasty of the lower eyelids

Changes in the relationship of the anterior globe to the orbital rim, orbit al fat, and cheek mass are examined in the present study. Two groups of ind ividuals (N = 28) were studied, young versus old, using three-dimensional c omputer tomography. A computer-derived soft tissue reformat of the data all owed the anterior-posterior changes to be evaluated at the midpupillary pla ne. Analysis of the data brings to light two important changes which occur with aging. First, the orbital rim moves posteriorly relative to the anteri or cornea with age (p = 0.0007). This is important because overresection of orbital fat during lower blepharoplasty accentuates the proptotic appearan ce of the eye which occurs naturally with age due to orbital remodeling. A second finding is that there is a tendency for the cheek mass to move poste riorly with age relative to the anterior cornea (p = 0.0038). The negative vector, a warning sign for lower blepharoplasty, becomes more common with a dvancing age. It is suggested that the presence of a negative vector is a s ign of generalized maxillary hypoplasia. Certain individuals with a negativ e vector can be further identified preoperatively by the clinical triad of scleral show, prominent medial fat, and a prominent nasojugal crease. These individuals likewise exhibit maxillary hypoplasia and may be more prone to complications after blepharoplasty. Lastly, a summated model of skeletal r emodeling is presented. The significant points are as follows. (1) contrary to previous work, the craniofacial skeleton remodels throughout adulthood, (2) changes in the skeletal architecture impart their effects on the overl ying soft tissues, and (3) facial aging is a summation of both hard and sof t tissue changes which occur throughout life.