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American Association of Plastic Surgeons

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Improvement In Upper Blepharoplasty Aesthetic Outcomes With Lid Crease Lateralization And The Role Of Pre-operative Pretarsal Show
Jonathan T. Bricker, BA1, Vishnu Venkatesh, BA1, Aakash R. Gupta, BA, MPH1, Elbert E. Vaca, MD1, Marco Ellis, MD1, Sammy Sinno, MD2, Thomas Mustoe, MD2, Mohammed Alghoul, MD, FACS1.
1Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 2Northwestern Memorial Hospital, Chicago, IL, USA.

Purpose: 
Our group showed that female eyelids with progressive lateralization of the 3 upper lid arcs are more attractive. The purpose of this study is to examine upper blepharoplasty aesthetic outcomes based upon preoperative pretarsal show and upper lid arc changes.
Methods: 
We retrospectively reviewed patients who had upper blepharoplasty from 1997-2017. Lash line, lid crease and brow peaks were measured. Patients were classified based on preoperative pretarsal show: I. None II. Partial III. Complete. Pre and post-operative photographs were randomized and given a cosmetic score from 0 to 5 by four blinded reviewers.
Results: 
316 patients (632 eyes) were included. On average, the lid crease peak moved 1.21 mm laterally, and brow peak 2.34 mm when combined with brow lift. The no show and partial show groups had greater lateralization of the lid crease peak (2.53, 2.21 mm, respectively) compared to complete show (0.57 mm) (p < 0.001). Post-operatively, Group II patients rated as attractive (cosmetic score ≥ 3) had more laterally located lid crease and brow peaks compared to those rated less attractive (≤ 1.5) (p = 0.01). Patients with greater lateralization of the lid crease peak had higher increases in aesthetic score (r = 0.3, p < 0.001).
Conclusion: 
Patients with partial or no pretarsal show achieved greater lid crease lateralization and improved aesthetic outcomes after upper blepharoplasty compared to patients with complete pretarsal show. Adjunctive surgical maneuvers including fat grafting or ptosis repair may be necessary to improve aesthetic outcomes in patients with complete pretarsal show.


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