title: Objective evaluation of the eyelids and eyebrows after blepharoplasty.
abstract: OBJECTIVE
  Surgery of the upper and lower eyelids and eyebrows is primarily designed to enhance the esthetic appearance and provide functional visual field benefits. Paramount to successful surgical results is a carefully executed examination and treatment plan. The preoperative and postoperative evaluation of these individuals has been primarily subjective. This article describes a method for the quantification of periorbital relationships that is of use in the preoperative planning and postoperative evaluation of patients undergoing esthetic surgery of the eyelids and eyebrows.
  
  
  METHODS
  The photographic records of 15 female patients who had undergone bilateral upper eyelid surgery were examined. None of the patients underwent lower eyelid or eyebrow surgery. Preoperative and postoperative frontal photographs were projected to a standard size, and measurements were made in a standardized fashion. For the comparison of intrapatient and interpatient relationships, objective anthropometric proportions rather than average measurements were used. Therefore, standard periorbital relationships were recorded and expressed as anthropometric ratios. Measurements were recorded for 30 eyes. The preoperative and postoperative relationships were measured and reported as mean values with standard deviation. The relationships studied were: 1) Upper lid height to orbit height, 2) Lower lid height to orbit height, 3) Lid sulcus height to orbit height, 4) Lid sulcus height to upper lid height, 5) Upper iris coverage to iris height, 6) Lower iris coverage to iris height, 7) Orbit height to middle facial height, 8) Medial brow to orbit height, 9) Lateral brow to orbit height, and 10) Eye fissure height to orbit height. Brow heights were measured vertically from a line connecting exocanthion and endocanthion.
  
  
  RESULTS
  The postoperative changes in these patients showed the following: Upper lid height, eye fissure height, and brow position were not significantly affected by upper lid blepharoplasty surgery. The sulcus lid height was doubled postoperatively, and upper iris coverage was decreased slightly postoperatively.
  
  
  CONCLUSIONS
  The results of the study indicate that the proposed methodology is appropriate for the objective evaluation of periorbital relationships pertinent to esthetic periorbital surgery. Its use is suggested as a diagnostic aid in preoperative planning and postsurgical evaluation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, John Peter Smith Hospital, Fort Worth, TX, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Starck
authors.forename: J E
authors.initials: JE
authors.lastname: Griffin
authors.forename: B N
authors.initials: BN
authors.lastname: Epker
mesh_terms: D000328:Adult; D000368:Aged; D002508:Cephalometry; D005069:Evaluation Studies as Topic; D005138:Eyebrows / Q000033:anatomy & histology; D005143:Eyelids / Q000033:anatomy & histology / Q000601:surgery*; D005145:Face / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010781:Photography; D012016:Reference Values; D013518:Surgery, Plastic / Q000592:standards*; D016896:Treatment Outcome