Traditional versus laterally extended upper blepharoplasty skin excisions: objective and patient reported outcomes

Abstract

Background: Different skin excision shapes may result in different aesthetic outcomes after upper blepharoplasty. Methods: Two skin-only excision shapes were evaluated objectively and subjectively in 28 matched patients with laterally extended skin excision (group A) or traditional elliptical skin excision (group B). The pretarsal show, lateral eyebrow height, amount of scarring (evaluated with the Patient and Observer Scar Assessment Scale), and patient-reported aesthetic results (evaluated using FACE-Q) were scored and compared at 6 and 12 months postoperatively. Results: In both groups, pretarsal show improved significantly after blepharoplasty. The homogeneity of pretarsal show improved significantly in the lateral extension group (group A) together with slightly more pretarsal show (0.5 to 0.8 mm at central pupil region) at 6 and 12 months of follow-up compared with group B (P = 0.004). A trend was observed in the exocanthion 45-degree measurement, in which group A had 0.6 mm greater pretarsal show 6 months postoperatively. Homogeneity of the pretarsal show had improved significantly in group A, but not in group B, at 12 months after blepharoplasty. No other significant differences were observed between the groups regarding pretarsal show measurements or FACE-Q scores. Both groups showed descent of the lateral eyebrow, but this was only significant in group B. Group B showed 1.4 to 2.0 mm more descent compared with group A. Scarring and adverse effects scores were low in both groups and did not differ. Conclusion: Laterally extended skin excision and traditional elliptical skin excision both result in positive aesthetic results, but the laterally extended skin excision technique is accompanied by a slightly more favorable outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Upper Blepharoplasty: An Evidence-Based Assessment of Preoperative Considerations and Surgical Techniques

“…The literature investigating the influence of upper blepharoplasty surgery on brow height is almost entirely limited to retrospective studies with inconsistent findings. Seven studies reported statistically significant lowering of the brow position (Level 2 and Level 3), [16][17][18][19][20][21][22] while six other studies identified no significant change in brow height (Level 2 and Level 3). [23][24][25][26][27][28] While the inconsistency in the existing literature limits strong evidence-based recommendations for preoperative patient counseling when coexisting mild brow ptosis is also present, some conclusions can be drawn.…”

“…Hollander et al compared the traditional method with a wide laterally extended upper blepharoplasty skin excision in a prospective comparative study (Level 3). 21 In comparison to the traditional design, the lateral extending skin excision began 5 to 6 mm above the medial canthus and curved superiorly, with the lateral portion positioned superiorly, spanning past the thin lid skin to reach the thick skin over the superolateral orbital rim. The lateral extension was positioned over and beyond the area of lateral hooding, placed at the height of the medial margin of the eyebrow (►Fig.…”