Ji Chenyang, Li Ruiting, He Wei, Zhang Jinming
Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou City.
Department of Plastic Surgery, Foshan Sanshui District People's Hospital, Foshan City, China.
J Craniofac Surg. 2018 Mar;29(2):482-485. doi: 10.1097/SCS.0000000000004158.
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.
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.
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.
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.
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.
部分无皱睑合并中度上睑下垂患者眉位较高，导致面中比例增大。除行眼睑成形术以形成动态皱襞外，如提上睑肌腱膜折叠等额外手术通过降低眉毛高度，有效改善了增大的面中比例，获得了良好的美学效果。然而，据作者所知，面部美学比例的具体变化以及这些变化的重要性在文献中严重缺乏。
测量接受提上睑肌腱膜折叠手术的无皱睑合并上睑下垂患者眉上缘与下睑缘之间的长度比（L1）/下睑缘与鼻基底之间的长度比（L2），并分析面中美学比例的变化。
收集2015年12月至2016年10月在作者科室接受提上睑肌腱膜折叠手术的21例无皱睑合并上睑下垂患者的术前和术后照片作为研究组。另外准备20位中国女性电影明星的全脸照片作为对照组。通过Adobe Photoshop CS6测量L1/L2（J）的比值。分析统计学意义并评估面中比例的变化。
研究组术前L1/L2（J1）的平均值为0.746，术后（J2）为0.657。对照组L1/L2（J3）的平均值为0.667。术前和术后样本之间以及术前样本与对照组之间存在统计学差异。术后样本与对照组样本之间无统计学差异。术后样本中L1与L2的比值接近对照组，更接近黄金比例。
提上睑肌腱膜折叠可有效降低上睑下垂患者的眉毛高度，缩短眉与下睑之间的长度，从而根据黄金分割理论获得更合适、更和谐的L1/L2比值。除睑裂大小和角膜暴露率外，术后面中美学比例的变化可作为术前沟通和术后效果评估的关键点。
