Trans-blepharoplasty lateral volumizing brow lift in the management of lateral upper eyelid dermatochalasis

Main Article Content

Tarek Elhamaky

Keywords

dermatochalasis, brow ptosis, blepharoplasty, browpexy, BFPSS, perioorbital

Abstract

Purpose: To investigate the efficacy of simultaneous upper eyelid blepharoplasty (UEB), internal browpexy (IB), and brow fat pad suspension suture (BFPSS) for periorbital rejuvenation. Methods: a prospective study of 96 eyelids of 48 patients who underwent simultaneous UEB, IB, and BFPSS was conducted. All patients underwent a periorbital evaluation and patient satisfaction was evaluated at baseline, 1 week, 3 months, and 6 months after the surgery. Results: The mean baseline BOE increased significantly from 37.5±2.9 points to 81.5±4.6 points at the 12-month follow-up. The mean baseline eyelid eyebrow distance (LBD) increased significantly from 19.1± 0.6 to 21.5± 1mm at the 12-month follow-up. The mean baseline pretarsal space increased significantly from 2.6± 0.58 to 4.5± 0.31mm at the 12-month follow-up. Baseline lateral dermatochalasis classification was graded into grades 1, 2, and 3 in 28 (29.16 %), 50 (52.09%), and 18 (18.75%) eyelids, respectively. At the 12-month follow-up, grade 0 was recorded in 87 (90.6 %) eyelids, and grade 1 was recorded in 9 (9.4 %) eyelids. Conclusions: Our cohort highlights how concurrent BFPSS and QIB are minimally invasive adjuncts to UEB in the treatment of lateral dermatochalasis of the upper eyelid. 

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References

1. Alghoul MS, Bricker JT, Venkatesh V, et al. Rethinking upper blepharoplasty: the impact of pretarsal show. Plast Reconstr Surg. 2020; 146(6):1239-47.
2. Sundaram H, Kiripolsky M. Nonsurgical rejuvenation of the upper eyelid and brow. Clin Plast Surg. 2013; 40(1):55-76.
3. Lee JW, Cho BC, Lee KY. Direct brow lift combined with suspension of the orbicularis oculi muscle. Arch Plast Surg. 2013; 40(5):603–609.
4. Bhattacharjee K, Misra DK, Deori N. Updates on upper eyelid blepharoplasty. Indian J
Ophthalmol. 2017; 65(7):551-8.
5. Glass LR, Lira J, Enkhbold E, et al. The lateral brow: position in relation to age, gender, and ethnicity. Ophthalmic Plast Reconstr Surg. 2014; 30(4):295-300.
6. Kashkouli MB, Abdolalizadeh P, Abolfathzadeh N, Sianati H, Sharepour M, Hadi Y. Periorbital facial rejuvenation; applied anatomy and pre-operative assessment. J Curr Ophthalmol. 2017; 29(3):154-68.
7. Huang C, Huang X, Jin R, et al. The Lateral Orbital Thickening and the Lateral Brow Thickening: A New Choice for the Lower Eyelid Suspension. J Craniofac Surg. 2022; 33(6):1748-53.
8. Briceno CA, Zhang-Nunes SX, Massry GG. Minimally invasive surgical adjuncts to upper blepharoplasty. Facial Plast Surg Clin North Am. 2015; 23(2):137–151.
9. Thornton IL, Clark J, Sokol JA, Hite M, Nunery WR. Radiographic evidence of prominent retro and suborbicularis oculi fat in thyroid associated orbitopathy. Orbit. 2016; 35(1):35e38.
10. Qiu Y, Shen Y, He J, et al. Sub-brow skin excision combined with retro-orbicularis fat resection: a technique for upper eyelid bulkiness and laxity correction. J Plast Reconstr Aesthet Surg. 2022; 75(4):1431-7.
11. Armstrong BK, Sobti D, Mancini R. Partial orbicularis resection for the augmentation of traditional internal brow Pexy: the “Tuck and Rise”. Ophthalmic Plast Reconstr Surg. 2016; 32(6):473-6.
12. Vrcek I, Chou E, Somogyi M, Shore JW. Volumization of the brow at the time of blepharoplasty: treating the eyebrow fat pad as an independent unit. Ophthalmic Plast Reconstr Surg. 2018; 34(3):209-12.
13. Kim WJ, Kim HK, Bae TH, Kim WS. Analysis of subbrow upper blepharoplasty by measuring the lid-to-brow distance. Archives of Aesthetic Plastic Surgery. 2019; 25(2):45-51.
14. Wang J, Su Y, Zhang J, Guo P, Guo P, Huang C, Song B. A randomized, controlled study comparing subbrow blepharoplasty and subbrow blepharoplasty combined with periorbital muscle manipulation for periorbital aging rejuvenation in Asians. Aesthetic Plast Surg. 2020; 44(3):788-96.
15. Kashkouli MB, Jamshidian-Tehrani M, Sharzad S, Sanjari MS. Upper blepharoplasty and lateral wound dehiscence. Middle East Afr J Ophthalmol. 2015; 22(4):452e456.
16. Turin SY, Vaca EE, Cheesborough JE,Sinno S, Mustoe TA. Simplified lateral brow lift under local anesthesia for correction of lateral hooding. Plast Reconstr Surg Glob Open. 2019; 7(6):e2098.
17. Huijing MA, van der Palen J, van der Lei B. The effect of upper eyelid blepharoplasty on eyebrow position. J Plast Reconstr Aesthet Surg 2014; 67(9):1242-7.
18. Levine MR, Allen RC, editors. Manual of oculoplastic surgery. Springer; 2018 Jun 26.
19. Eftekhari K, Peng GL, Landsberger H, Dougla R, Massry GG. The brow fat pad suspension suture: safety profile and clinical observations. Ophthalmic Plast Reconstr Surg. 2018; 34(1):7-12
20. Karimi N, Kashkouli MB, Sianati H, Khademi B. Techniques of eyebrow lifting: a narrative review. J Ophthalmic Vis Res. 2020; 15(2):218-235.
21. Silva KR, Rossi DC, Petroianu A. A new classification of the lateral dermatochalasis of upper eyelids. Plast Reconstr Surg Glob Open. 2021; 9(7):e3711.
22. Elhamaky TR. Small incision upper blepharoplasty in the treatment of upper eyelid solitary nasal pad fat protrusion. J Cutan Aesthet Surg. 2023; 16(3):210-3.
23. Figueiredo MN, Tao J, Akaishi P, Limongi RM. Tarsal platform show after upper eyelid blepharoplasty with or without brassiere sutures. Arq Bras Oftalmol. 2017; 80(6):345-9.
24. Lam VB, Czyz CN, Wulc AE. The brow-eyelid continuum: an anatomic perspective. Clin Plast Surg. 2013; 40(1):1e19.
25. Baker MS, Shams PN, Allen RC. The quantitated internal suture browpexy: comparison of two brow-lifting techniques in patients undergoing upper blepharoplasty. Ophthalmic Plast Reconstr Surg. 2016; 32(3):204-6.
26. Broadbent T, Mohktarzadeh A, Harrison A. Minimally invasive brow lifting techniques. Curr Opin Ophthalmol. 2017; 28(5):539-43.
27. Cohen BD, Reiffel AJ, Spinelli HM. Browpexy through the upper lid (BUL): a new technique of lifting the brow with a standard blepharoplasty incision. Aesthet Surg J 2011; 31(2):163-169.
28. Ghadiali LK, Winn BJ. Internal Lateral Browpexy. Operative Dictations in Ophthalmology. 2021:709-11.
29. Massry GG. The external browpexy. Opthalmic Plast Reconstr Surg. 2012; 28(2):90–5.
30. Georgescu D, Belsare G, McCann JD, Anderson RL. Adjunctive procedures in upper eyelid blepharoplasty: internal brow fat sculpting and elevation, glabellar myectomy, and lacrimal gland repositioning. Master techniques in blepharoplasty and periorbital rejuvenation. 2011:101-8.
31. Azizzadeh B, Murphy MR, Johnson CM, Massry GG. Master techniques in facial rejuvenation e-book. Elsevier Health Sciences; 2018 Jan 26.
32. Mancini R. Nonsurgical considerations for addressing periocular aesthetics: a conceptual dimensional approach. JAMA Facial Plast Surg. 2014; 16(6):451–6.
33. Georgescu D, Anderson RL, McCann JD. Brow ptosis correction: a comparison of five techniques. Facial Plast Surg. 2010; 26(3):186–92.
34. Varshney N, Lin JL, Kohn JC, Isaacs DK, Hoenig JA, Goldberg RA.Using a brassiere suture technique to define lateral tarsal platform and eyebrow fat contours. Paper presentation at: ASOPRS 2012 Fall Symposium.
35. Iblher N, Manegold S, Porzelius C, Stark GB. Morphometric long-term evaluation and comparison of brow position and shape after endoscopic forehead lift and transpalpebral browpexy. Plast Reconstr Surg. 2012; 130(6):830e–840e.
36. Zhang YS, Zhou Q, Zhang J, et al. Local retro-orbicularis oculus fat (ROOF) resection in upper blepharoplasty: A retrospective evaluation study of 65 bilateral upper blepharoplasties. J Plast Reconstr Aesthet Surg. 2019; 72(8):1373-8.
37. Papageorgiou KI, Mancini R, Garneau HC, et al. A three-dimensional construct of the aging eyebrow: the illusion of volume loss. Aesthet Surg J. 2012; 32(1):46–57.
38. Stanek JJ, Fuller JC, Hilger PA. Brassiere suture technique in upper eyelid blepharoplasty. JAMA Facial Plast Surg. 2019; 21(5):458-9.
39. Silva JJ, Vaz RT, Ohmuro ML, de Santana ES, Lira RPC. Brow Lift Through the Upper Blepharoplasty Incision: Prospective Clinical Study. Aesthetic Plast Surg. 2023; 47(5):1851-1858.