Abstract
Background
Improving periorbital aging is, currently, of great concern. The previous literature has reported some surgical methods for periorbital aging. The purpose of this study was to compare subbrow blepharoplasty (SBB) with subbrow blepharoplasty combined with periorbital muscle manipulation (SBB-pm) with regard to improving periorbital aging.
Methods
A prospective, randomized, controlled study was designed to evaluate and compare the effects of two different surgical techniques on upper lid relaxation, brow shape and periorbital wrinkles. Patients were divided into two groups. Group 1 underwent resection of excess skin; group 2 underwent a modified technique that involved resection of an elliptical island of skin, separation of the corrugator supercilii muscle and dissection of the orbicularis oculi muscle, followed by suturing it to the orbital periosteum and cross-fixation with itself. The upper eyelid and eyebrow height, periorbital wrinkle score and patient satisfaction were measured preoperatively and postoperatively.
Results
This study included 70 patients (140 eyes). At 1 month, 3 months, 6 months and 12 months after surgery, group 2 was superior to group 1 with regard to the improvement in upper eyelid relaxation at the medial limbus, middle pupil and lateral canthus. The eyebrow assumed a low and flat appearance in group 1. The eyebrow showed a low and flat appearance and then returned to the preoperative level in group 2. When comparing the two surgical techniques, the authors found statistically significant differences in regard to changes in crow’s feet and glabellar frown lines. Two patients in group 2 experienced forehead numbness after surgery, which resolved by the 6-month follow-up. Patients in group 2 were significantly more satisfied with their surgery than patients in group 1.
Conclusion
SBB-pm is more effective than SBB for improving upper eyelid relaxation and preventing secondary brow ptosis after surgery as well as for alleviating periorbital wrinkles, although it is accompanied by transient forehead numbness.
Level of Evidence II
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.
Similar content being viewed by others
References
Branham G, Holds JB (2015) Brow/upper lid anatomy, aging and aesthetic analysis. Facial Plast Surg Clin N Am 23(2):117–127
Alghoul M (2019) Blepharoplasty: anatomy, planning, techniques, and safety. Aesthet Surg J 39(1):10–28
Kim YS, Roh TS, Yoo WM, Tark KC, Kim J (2008) Infrabrow excision blepharoplasty: applications and outcomes in upper blepharoplasty in Asian women. Plast Reconstr Surg 122(4):1199–1205
Lee D, Law V (2009) Subbrow blepharoplasty for upper eyelid rejuvenation in Asians. Aesthet Surg J 29(4):284–288
Kunjur J, Sabesan T, Ilankovan V (2006) Anthropometric analysis of eyebrows and eyelids: an inter-racial study. Br J Oral Maxillofac Surg 44(2):89–93
Ichinose A, Sugimoto T, Sugimoto I, Ishinagi H, Kuwazuru K, Nagai K et al (2011) Extended infrabrow excision blepharoplasty for dermatochalasis in Asians. Arch Facial Plast Surg 13(5):327–331
Fang Y, Liao W, Ma H (2013) Infraeyebrow blepharoplasty incorporated browpexy in an Asian population. Ann Plast Surg Suppl 1:S20–S24
Wang J, Su Y, Zhang J, Guo P, Song B (2019) Subbrow blepharoplasty combined with periorbital muscle manipulation for periorbital rejuvenation in Asian women. Plast Reconstr Surg 144(5):760e–769e
Lemperle G, Holmes RE, Cohen SR, Lemperle SM (2001) A classification of facial wrinkles. Plast Reconstr Surg 108(6):1735–1750
Parkes ML, Kamer FM, Merrin ML (1976) Infrabrow lift. Laryngoscope 86(12):1869–1872
Kim YS (2014) Subbrow blepharoplasty using supraorbital rim periosteal fixation. Aesth Plast Surg 38(1):27–31
Sugamata A (2012) Infraeyebrow blepharoplasty for blepharochalasis of the upper eyelid: its indication and priority. Plast Surg Int 2012:975097
Pottier F, El-Shazly NZ, El-Shazly AE (2008) Aging of orbicularis oculi: anatomophysiologic consideration in upper blepharoplasty. Arch Facial Plast Surg 10(5):346–349
Hoorntje LE, Lei B, Stollenwerck GA, Kon M (2010) Resecting orbicularis oculi muscle in upper eyelid blepharoplasty—a review of the literature. J Plast Reconstr Aesthet Surg 63(5):787–792
Lee JW, Cho BC, Lee KY (2013) Direct brow lift combined with suspension of the orbicularis oculi muscle. Arch Plast Surg 40(5):603–609
Knize DM (2009) Anatomic concepts for brow lift procedures. Plast Reconstr Surg 124(6):2118–2126
Langsdon P, Karter N (2018) Manipulation of the periorbital musculature. Facial Plast Surg 34(2):194–200
Graf RM, Tolazzi AR, Mansur AE, Teixeira V (2008) Endoscopic periosteal brow lift: evaluation and follow-up of eyebrow height. Plast Reconstr Surg 121(2):609–616
Viterbo F (2003) New treatment for crow's feet wrinkles by vertical myectomy of the lateral orbicularis oculi. Plast Reconstr Surg 112(1):275–279
Funding
The authors received no financial support for the research, authorship and publication of this article.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Ethical Approval
The trial protocol was approved by Xijing Hospital Institutional Review Board. The study was performed in accordance with the Helsinki Declaration and Good Clinical Practice.
Informed Consent
Written consent was obtained from all patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Wang, J., Su, Y., Zhang, J. et al. A Randomized, Controlled Study Comparing Subbrow Blepharoplasty and Subbrow Blepharoplasty Combined with Periorbital Muscle Manipulation for Periorbital Aging Rejuvenation in Asians. Aesth Plast Surg 44, 788–796 (2020). https://doi.org/10.1007/s00266-020-01630-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-020-01630-4