American Association of Plastic Surgeons

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Rethinking Upper Blepharoplasty: Critical Analysis Of Aesthetic Outcomes And Presenting Features
Jonathan T. Bricker, BA1, Vishnu Venkatesh, BA1, Aakash R. Gupta, BA, MPH1, Thomas Mustoe, MD2, Mohammed Alghoul, MD, FACS2.
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Northwestern Memorial Hospital, Chicago, IL, USA.

Purpose: 
Conventional upper blepharoplasty relies on skin and fat excision to restore ideal pretarsal space to upper lid fold ratios. The purpose of this study is to identify presenting topographic features of upper blepharoplasty patients and their effect on cosmetic outcomes.
Methods: 
This is a retrospective review of patients who had upper blepharoplasty at our institution from 1997-2017. Exclusion criteria included ptosis without repair and missing photographs. Photos were standardized using Adobe Illustrator to a pupil diameter of 11.5-mm. Pretarsal space and upper lid fold heights were measured at five locations and brow shape was determined. Patients were classified into three groups based on preoperative pretarsal show: I. None II. Partial III. Complete. Photos were randomized in PowerPoint and given a cosmetic score from 0 to 5 by four reviewers.
Results: 
Three hundred nineteen patients were included, 40 males (12.5%) and 279 females (87.5%), mean age of 55. Preoperative favorable brows were seen in 43%. Group I included 102 eyes (16%), Group II 159 (25%) and Group III 373 (59%). Mean cosmetic score increased from 1.75 preop to 2.38 postop (p < .001), with a greater increase in Groups I and II (1.17 and 0.92, respectively) compared to Group III (0.39) (p < 0.005). Eyes with a preop favorable brow had higher postop cosmetic ratings (2.47) than those with an unfavorable brow (2.24) (p < .05).
Conclusion: 
Many patients presenting for upper blepharoplasty have complete pretarsal show and are at risk for worse cosmetic outcomes using conventional skin excision techniques.


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