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Aesthetic Plastic Surgery

, Volume 42, Issue 6, pp 1551–1555 | Cite as

Horizontal Forehead Lines: A Reflection of Eyelid Ptosis or Blepharodermachalasia

  • Yuewei Wu-Fienberg
  • Kunaal R. Bafna
  • Bahman Guyuron
Original Article Facial Surgery
  • 113 Downloads

Abstract

Background

In his facial aesthetics practice, the senior author (B.G.) observed that many patients presenting with horizontal forehead lines also demonstrated upper eyelid ptosis or enough blepharodermachalasia to require compensation. This study was conducted to investigate this observation.

Methods

Photographs of patients presenting for facial rejuvenation were retrospectively reviewed for the presence of forehead lines, ptosis, brow ptosis, and blepharodermatochalasia. Patient age, gender, and race were reported. Only patients over age 50 were included. Patients who had previous eyelid or forehead surgery, congenital abnormalities, or post-traumatic deformities were excluded. Ptosis was defined as more than 1.5-mm overlap between the upper eyelid and the iris. Patients were divided into two groups based on presence of forehead lines for comparative analysis.

Results

One hundred sixty patients, including 100 patients with and 60 patients without horizontal forehead lines, were included. Patients with forehead lines were likely to be older (age 61.56 ± 8.93 vs. 58.58 ± 7.59; P = 0.0337), male (36 vs. 11.67%; P = 0.0008), have ptosis (90 vs. 76.67%; P = 0.0377), and have blepharodermatochalasis (20 vs. 5%; P = 0.0097). All 28 patients with unilateral forehead lines (17 left, 11 right) had ipsilateral ptosis.

Conclusions

Ptosis and blepharodermatochalasis may result in the development of horizontal forehead lines through compensatory frontalis activation. Whenever horizontal forehead rhytids are noted, it is imperative to search for ptosis or blepharodermachalasia in repose. Otherwise, forehead rejuvenation may fail to eliminate these compensatory forehead lines, and chemodenervation may have significant adverse effects on the visual field by forcibly blocking frontalis compensation.

Level of Evidence III

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.

Keywords

Forehead lines Ptosis Blepharodermatochalasia Frontalis Compensation 

Notes

Compliance with Ethical Standards

Conflict of interest

None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2018

Authors and Affiliations

  • Yuewei Wu-Fienberg
    • 1
  • Kunaal R. Bafna
    • 2
  • Bahman Guyuron
    • 1
    • 3
  1. 1.Department of Plastic SurgeryUniversity Hospitals Cleveland Medical CenterClevelandUSA
  2. 2.University of Toledo College of Medicine and Life SciencesToledoUSA
  3. 3.ClevelandUSA

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