The Aesthetic Analyzing of Midface Ratio After Folding Aponeurosis of Levator Palpebrae Superioris Muscle in the Ptosis Correction

Background: Some fordless-eyelid patients with moderate upper lid ptosis characterize in a higher eyebrow position which leads to an increased midfacial ratio. Apart from performing blepharoplasty to create dynamic folds, additional procedures such as folding aponeurosis of levator palpebrae superioris muscle were effective to revise the enlarged ratio of midface through lowering eyebrow, which gains good aesthetic results. However, the specific changes in the proportion of facial aesthetics and the importance of these change were serious lack in the literature as far as the authors know. Purpose: To measure the ratio of the length between upper edge of eyebrow and edge of lower eyelid (L1)/the length between edge of lower eyelid and nasal base (L2) in the fordless-eyelid and upper lid ptosis patients who received levator aponeurosis folding surgery, and to analyze the change in the proportion of midfacial aesthetics. Method: From December 2015 to October 2016, the pre- and postoperative photographs from 21 cases of patients with foldless eyelid and upper lid ptosis who underwent the levator aponeurosis folding procedures in the authors' department were collected as study group. Additional full-face pictures of 20 Chinese female movie stars were prepared as control group. The ratios of L1/ L2 (J) were measured via Adobe Photoshop CS6. The statistical significance was analyzed and the change of midfacial proportion was evaluated. Result: In the study group, the mean value of preoperative L1/L2 (J1) is 0.746, and (J2) 0.657 postoperatively. In the control group, the mean value of L1/L2 (J3) is 0.667. Statistical differences showed between the pre- and postoperative samples and between preoperative samples and control group. There was no statistical difference between postoperative samples and control group samples. The ratios between L1 and L2 in postoperative samples are close to those in the control group, which are closer to the golden radio. Conclusion: Levator aponeurosis folding can effectively lower eyebrow in patients with upper lid ptosis, shortening the length between eyebrow and lower eyelid, and therefore harvesting a more appropriate and harmonious ratio of L1/ L2 according to the golden section theory. The changes in the proportion of midfacial aesthetics after operation could be used as a key point in the preoperative communication and postoperative effect evaluation, besides the size of palpebral fissure and corneal exposure rate. Address correspondence and reprint requests to Chenyang Ji, MD, Sun Yat-Sen University, 33 NO. of Yingfeng Street, Guangzhou City, Guangdong Province, China; E-mail: jichenyang@163.com Received 10 July, 2017 Accepted 28 August, 2017 The authors report no conflicts of interest. © 2017 by Mutaz B. Habal, MD.

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