Upper Eyelid Blepharoplasty Improved the Overall Periorbital Aesthetics Ratio by Enhancing Harmony Between the Eyes and Eyebrows

Abstract

Purpose: In upper eyelid blepharoplasty, most aesthetic surgeons and patients focus on improvements in the appearance of the upper eyelids, such as changing the vertical dimension of the palpebral fissure and the width of the pretarsal crease. Nevertheless, appropriately balanced periorbital aesthetics stemming from harmony between the eyelids and eyebrows is often ignored. The aim of this study was to explore the use of upper eyelid blepharoplasty to improve the overall periorbital aesthetics by enhancing the harmony between the eyes and eyebrows in young Asian women.

Patients and methods: From December 2019 to December 2020, 45 young Asian female patients underwent external incision upper eyelidplasty without ptosis repair or brow lift at The Second Affiliated Hospital of Harbin Medical University. The pre- and 6-month post-operative follow-up changes in the overall periorbital aesthetics were studied retrospectively.

Results: The vertical position of the eyebrows in the upper face and shape of the brow apex were significantly improved after surgery. As a result, the height of the upper face was increased. Furthermore, the facial width proportion and midface ratio were closer to the ideal aesthetic golden ratio due to changes in the size of the periorbital area. All patients were satisfied with the result, and they achieved excellent surgical outcomes for not only the upper eyelids but also the overall periorbital region.

Conclusion: This study revealed that upper eyelid blepharoplasty, which enhances the appearance of the upper eyelids while regulating the eyelid position and shape of the eyebrows by considering the eye to eyebrow ratio, optimizes the proportion of the periorbital area and improves the overall periorbital aesthetics.

Keywords: eyebrows; eyelid blepharoplasty; facial proportions; periorbital aesthetics.

Figure 1

Preoperative photograph of the patient.

Figure 2

Medial canthus to medial canthus is measured as X; medial canthus to ipsilateral cheek apex is measured as Y = 1.618x. The distance between the upper edge of the eyebrow and the edge of the lower eyelid (a) and the distance between the edge of the lower eyelid and the nasal base (b) were measured.

Figure 3

(A and B) both show the changes in the eyebrow shape before and after surgery. Before the operation (Left). Three months after external incision upper eyelidplasty (Right). The indicators of H1~H6 are shown in Table 1.

Figure 4

Graphical plots of the changes in the landmark data before and after surgery. The change in the position of the brows shown in.Figure 3 can be clearly seen in Figure 4.

Figure 5

The overall changes before and after surgery Case 1. (A) Before the operation. (B) Two months after upper eyelidplasty.

Figure 6

The overall changes before and after surgery Case 2. (A) Before the operation. (B) Six months after upper eyelidplasty.

Figure 7

The bar chart of the average variation in facial proportion before and after surgery. Data are represented as mean ± SD. n = 3. *P < 0.05, ****P < 0.0001.

Figure 8

(A) Photograph of the patient who was not satisfied with her appearance. (B) At the end of 6 months post-operation, the patient was satisfied with the results and became more confident.

Figure 9

(A) Photograph of the patient who looked exhausted before surgery. (B) Immediately after surgery, her MRD1 had significantly increased, her forehead was larger, eyebrows were lower, and facial proportions became more harmonious. She looked more attractive and alert after the operation.