title: The Measurement of Palpebral Fissure Height Using the Intersection Angle (the Réal Angle) Between the Meeting Points of the Upper Eyelid and the Edge of the Cornea.
abstract: BACKGROUND
  We evaluated a new palpebral fissure height measurement to evaluate medial, lateral, and overall ptosis.
  
  
  METHODS
  We photographed 250 Koreans (44 males, 206 females) and evaluated their Réal 1 angle (angle between the meeting points of the upper eyelid and the corneal edge), Réal 2 angle (angle between the meeting point of the upper eyelid, medial corneal edge and a vertical line through the center of the pupil), Réal 3 angle (angle between the meeting point of the upper eyelid, lateral corneal edge and a vertical line through the center of the pupil), and Réal 4 angle (Réal 2-Réal 3). Angles were compared between sexes and age groups. We then evaluated the Réal angles of 13 Korean actresses.
  
  
  RESULTS
  Mean age was 31.85 ± 14.60 years; Réal 1 was 129.01° ± 14.23°, Réal 2 was 68.20° ± 7.49°, Réal 3 was 60.80° ± 9.65°. There was no significant difference between the sexes in Réal 1, Réal 2, and Réal 3 angles. Réal 1 increased with age, and Réal 4 decreased with age. All Réal angles were significantly different between age groups. The actresses' mean age was 30.66 ± 8.01 years; Réal 1 was 102.84° ± 10.16°, Réal 2 was 57.87° ± 6.10°, and Réal 3 was 44.97° ± 8.74°.
  
  
  CONCLUSIONS
  This simple measurement of palpebral fissure height using Réal angles consistently evaluated the amount of medial, lateral, and general ptosis. For average Korean eyes, the lateral portion of the upper eyelid is slightly higher than the medial portion; however, this lateral portion droops with age. Korean actresses have vertically higher eyes than average Korean women.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: The Plastic Surgical Clinic, 5F, Gujeong Building, 868, Nonhyeon-ro, Gangnam-gu, Seoul, 06022, Republic of Korea.
authors.forename: Hun Joo
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Réal Cosmetic Clinic, 2F, Asia Building, 580 Sinsa-dong, Gangnam-gu, Seoul, 135-892, Republic of Korea. kim1624@hotmail.com.
authors.forename: Soo Shin
authors.identifier: http://orcid.org/0000-0002-2724-7383
authors.initials: SS
authors.lastname: Kim
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000175:diagnosis / Q000208:ethnology / Q000601:surgery*; D015331:Cohort Studies; D003315:Cornea / Q000033:anatomy & histology*; D004954:Esthetics; D005143:Eyelids / Q000033:anatomy & histology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D056910:Republic of Korea; D012189:Retrospective Studies; D016896:Treatment Outcome; D014894:Weights and Measures; D055815:Young Adult
keywords: Blepharoplasty; Lateral hooding; Lateral ptosis; Medial ptosis; Ptosis; Réal angle