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°.
Conclusion
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.
Level of Evidence V
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
Small R, Sabates N, Burrows D (1989) The measurement and definition of ptosis. Ophthal Plast Reconstr Surg 5:171–175
Coombes AG, Sethi CS, Kirkpatrick WN, Waterhouse N, Kelly MG, Joshi N (2007) A standardized digital photography system with computerized eyelid measurement analysis. Plast Reconstr Surg 120:647–656
Boboridis K, Assi A, Indar A, Bunce C, Tyers AG (2001) Repeatability and reproducibility of upper eyelid measurements. Br J Ophthalmol 85:99–101
Kunjur J, Sabesan T, Ilankovan V (2006) Anthropometric analysis of eyebrows and eyelids: an inter-racial study. Br J Oral Maxillofac Surg 44:89–93
Park JS, Ham KS, Yoon JK, Cho YJ (1990) Study on the beauty sense for the eyes in Korean. J Korean Soc Plast Reconstr Surg 17:196–200
Rhee SC, Woo KS, Kwon BS (2012) Biometric study of eyelid shape and dimensions of different races with references to beauty. Aesth Plast Surg 36:1236–1245
Park JW, Kang MS, Nam SM, Kim YB (2015) Blepharoptosis correction with buried suture method. Ann Plast Surg 74:152–156
Hirohi T, Yoshimura K (2011) Vertical enlargement of the palpebral aperture by static shortening of the anterior and posterior lamellae of the lower eyelid: a cosmetic option for Asian eyelids. Plast Reconstr Surg 127:396–406
Neligan PC (2013) Asian facial cosmetic surgery. In: Koh KS, Choi JW, Ishii CH (eds) Plastic surgery, 3rd edn. Elsevier, Seattle, pp 169–170
Shin YH, Hwang K (2013) Cosmetic lateral canthoplasty. Aesth Plast Surg 28:317–320
Cho IC (2013) The art of blepharoplasty. Koonja, Seoul, pp 193–194
Lee H, Lee JS, Chang M, Park M, Baek S (2014) Analysis of lid contour change with aging in Asians by measuring midpupil lid distance. Plast Reconstr Surg 134:521e–529e
Kim CY, Son BJ, Lee SY (2015) Functional centre of the upper eyelid: the optimal point for eyelid lifting in ptosis surgery. Br J Ophthalmol 99:346–349
Park DH, Choi WS, Yoon SH, Song CH (2008) Anthropometry of Asian eyelids by age. Plast Reconstr Surg 121:1405–1413
Nemet AY (2015) Accuracy of marginal reflex distance measurements in eyelid surgery. J Craniofac Surg 26:e569–e571
Martin JJ (2013) Ptosis repair in aesthetic blepharoplasty. Clin Plast Surg 40:201–212
Flynn TH, Rose GE, Shah-Desai SD (2011) Digital image analysis to characterize the upper lid marginal peak after levator aponeurosis repair. Ophthal Plast Reconstr Surg 27:12–14
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.
Rights and permissions
About this article
Cite this article
Lee, H.J., Kim, S.S. 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. Aesth Plast Surg 41, 573–579 (2017). https://doi.org/10.1007/s00266-017-0808-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-017-0808-0