Subbrow Blepharoplasty Combined with Periorbital Muscle Manipulation for Periorbital Rejuvenation in Asian Women

Abstract

Background: With advancing age, Asian women are often plagued by lateral hooding of the upper eyelid skin, eyebrow ptosis, and obvious periorbital wrinkles. The authors propose a novel technique to revive the natural eyelid shape with a stable eyebrow position and alleviate periorbital wrinkles in Asian women. Methods: Sixty-six patients underwent subbrow blepharoplasty combined with periorbital muscle manipulation. An ellipse shape of the skin and subcutaneous tissue below the eyebrow was measured, demarcated, and removed. Then, the orbicularis oculi muscle beneath the subcutaneous tissue was exposed and dissected at the upper third. The lower muscle flap was fixed to the supraorbital rim periosteum and the upper musculocutaneous flaps, forming a cross flap for interlocking fixation. The lateral border of the orbicularis oculi muscle was detached from the subcutaneous tissue, splayed out, and sutured upward and inward to the periosteum. The corrugator supercilii muscle temporal to the origin of the supraorbital nerve notch was separated by 1 to 2 mm. The operation results were evaluated by patient satisfaction and comparisons between preoperative and postoperative photographs. Results: Subbrow blepharoplasty combined with periorbital muscle manipulation significantly corrected lateral hooding with a stable eyebrow position and reduced the crow’s feet and glabellar frown lines in all patients. The persistence of the improved outcome was stable during the follow-up period. Postoperative scarring was inconspicuous; however, eight cases had transient postoperative forehead numbness. Conclusions: This novel procedure provides a simple, effective, and comprehensive technique for improving periorbital aging in Asian women. The surgical outcomes are predictable, and the postoperative scarring is inconspicuous. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Parallel-excision infrabrow blepharoplasty with extensive excision of the orbicularis oculi muscle in an Asian population

“…The eyes of Asian individuals tend to have small horizontal and vertical pupillary fissures with lateral puffiness and weak double folds [12,13]. In addition to the above features, 70% of patients have frontalis muscle compensation.…”

Subbrow Lift Using Frontalis Sling to Correct Lateral Orbital Laxity

“…The first method is excision of the subbrow skin only [ 10 ]. The other method is fixating the lower flap to the upper orbital periosteum [ 12 , 13 ]. Although the excision of the skin technique is simple, it leads to early recurrence and somewhat noticeable scarring due to tension.…”

“…In previously described subbrow excision techniques, the skin is simply excised [8][9][10] or the orbicularis oculi muscle is excised and the lower flap is fixated to the periosteum [11,12]. The simple skin excision is prone to early recurrence.…”

Blepharoplastik bei asiatischen Augen

“…Daher ist die Beibehaltung eines "single eyelid", obwohl vereinzelt beschrieben, technisch im Normalfall nicht möglich und sinnvoll. Sollte ein "double eyelid" als Ergebnis abgelehnt werden, bleibt prinzipiell nur der Zugang unterhalb der Augenbraue, da Zugänge im Oberlid bei einem "single eyelid" deutlich sichtbar bleiben [4,6].…”

“…Sollte ein "double eyelid" von Patienten abgelehnt werden, so ist von einem Eingriff abzuraten. Obwohl vereinzelt Techniken die Beibehaltung eines "single eyelid" beschreiben, ist dies technisch schwierig umzusetzen [4,6]. Um die asiatischen Charakteristika nicht zugunsten eines europäischen Aussehens verschwinden zu lassen, müssen die Charakteristika der asiatischen Lidumschlagsfalte respektiert und durch den Eingriff betont und nicht "auskorrigiert" werden [8].…”