Infraeyebrow Blepharoplasty for Blepharochalasis of the Upper Eyelid: Its Indication and Priority

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. 1. Introduction 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 [1–6]. By using this operative technique, baggy appearance and blepharochalasis can be improved without extreme changes to a patient’s facial appearance after the operation. This paper provides our functional indications for upper lid blepharoplasty. 2. Materials and Methods 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 1). Table 1: Characteristics of patients ( ). 2.1. Design 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