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Page 2 of 9 Sforza et al. Plast Aesthet Res 2018;5:2 I http://dx.doi.org/10.20517/2347-9264.2017.35

A

B

Figure 1. (A) preoperative picture: patient 67 years old, male, presenting ptosis of the lateral third of the eyebrow (identified with the
white arrow), not diagnosed at the time; (B) postoperative picture: 6 months after, the remaining excess skin on the lateral third of the
eyebrow (identified with the white arrow) is a common cause of complaint from various patients

effective, quick and with high success rate. The nature of the procedure therefore sets high expectations with
less understanding of the need for any potential revision surgery.

Residual fat on the medial compartment and remaining excess skin on the lateral third of the upper eyelid
are probably the most common causes of patient dissatisfaction. This excess skin most of the times is not
related to a conservative removal or a technique failure. Otherwise, it is caused by an undiagnosed ptosis of
the lateral eyebrow [Figure 1].

Generally, eyebrows are just above the superior orbital rim in men and slightly higher in women. Many
patients asking for an upper blepharoplasty complain about excessive skin on the eyelid . When asked to
[1]
demonstrate how they would like the final result to be, patients instinctively use their hands to raise the
lateral third of the eyebrow as a sign of a youthful desired result. This clearly illustrates that the problem
cannot be merely a redundancy of the eyelid skin.

In this paper, the authors discuss the eyebrow position and this experience with a simple technique to be
associated with the upper blepharoplasty. The authors have performed a clinical audit of 179 patients who
underwent this procedure between the years of 2008 and 2009. The detailed content of the paper will also
allow other surgeons to reproduce every step of the technique.

METHODS
Preoperative identification of patients presenting ptosis of the lateral eyebrow is very important. In this
retrospective analysis, it was confirmed that the evaluation of the position of the eyebrows was present in all
preoperative consultation forms. Patients with lacrimal gland prolapse were not included in the study and
can be considered a contraindication for this procedure until the prolapse is investigated and corrected. The
patients were 95% female (n = 170) and 5% male (n = 9), with ages ranged between 43 and 63 years old. All
patients had their surgical procedure performed with the same surgical team. They had upper blepharoplasty
associated or not with other procedures (lower blepharoplasties and/or facelifts). This clinical audit followed
the Declaration of Helsinki guidelines and a written consent for the outlined procedure was obtained from
all patients.