Factors that influence the postoperative upper eyelid position following surgery for involutional blepharoptosis

Background Age-related changes in the periocular areas are mainly caused by anatomical changes of the bony orbit and orbicularis oculi muscle (OOM). To achieve effective rejuvenation, it is necessary to understand these anatomical changes according to age. Objectives We analyzed the configuration of the bony orbit and OOM using computed tomography (CT) and evaluated the effects of aging on these structures. Methods A total of 220 orbits and OOMs of 110 Japanese participants (55 males, 55 females) aged 20-87 years were enrolled. The long diameter of the orbits, orbital ellipticity, OOM thickness, and OOM attachment to the inferior orbital rim were analyzed. These variables were statistically evaluated for their relationship with age. Results The long diameter of the orbit was significantly longer in those over than in those under 60 years, with a moderate and significant positive correlation between orbital ellipticity and age. OOM thickness and age showed a strong negative correlation. The degree of OOM attachment to the inferior orbital rim decreased significantly with age. Conclusions This study showed that age-related changes of the bony orbit in Japanese individuals tended to be the same as those in Caucasians, but there were differences in degree of changes observed. As a new finding in the Japanese population, the OOM not only thins with aging, but also gradually loosens from the facial bone. In the elderly, only the nasal side of the OOM was attached to the bone. In clinical application, this could contribute to the development of cosmetic surgeries.

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Basic Consideration for Facial Aging: Age-Related Changes of the Bony Orbit and Orbicularis Oculi Muscle in East Asians

Okuda

Akita

Komemushi³

et al. 2022

Aesthetic Surgery Journal

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Influence of the Phenylephrine Test in Outcomes of External Levator Advancement for Involutional Ptosis

Chaneac,

Bertrand,

Schmid

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: This study aims to evaluate the influence of preoperative phenylephrine testing on the surgical outcome of patients undergoing surgery for involutional ptosis by external levator advancement. Methods: This was an observational, monocentric, retrospective study. Fifty-one eyelids from 32 patients, who had surgery between January 2018 and May 2023, were included for analysis. Preoperative clinical examination data were collected. Evaluation was performed at 1 month postoperatively. Surgical success was defined by a postoperative margin reflex distance between 3 and 5 mm inclusive. Symmetry success was defined by a difference in margin reflex distance between the 2 upper eyelids of no more than 1 mm. Results: The surgical success rate was 86%. A positive preoperative phenylephrine test was significantly associated with a better surgical success rate (p = 0.01), including on symmetry (p = 0.01). The secondary outcomes, namely preoperative margin reflex distance, function of the upper eyelid levator muscle, and unilaterality of surgery, were not statistically associated with surgical outcome. Conclusions: The phenylephrine test is a predictive factor of surgical success in patients undergoing external levator advancement. Our study suggests that patients with a negative phenylephrine test should be overcorrected intraoperatively.

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Factors that influence the postoperative upper eyelid position following surgery for involutional blepharoptosis

Cited by 2 publications

References 33 publications

Basic Consideration for Facial Aging: Age-Related Changes of the Bony Orbit and Orbicularis Oculi Muscle in East Asians

Basic Consideration for Facial Aging: Age-Related Changes of the Bony Orbit and Orbicularis Oculi Muscle in East Asians

Influence of the Phenylephrine Test in Outcomes of External Levator Advancement for Involutional Ptosis

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