Wu-Fienberg Yuewei, Bafna Kunaal R, Guyuron Bahman
Department of Plastic Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
University of Toledo College of Medicine and Life Sciences, 3000 Arlington Ave, Toledo, OH, 43614, USA.
Aesthetic Plast Surg. 2018 Dec;42(6):1551-1555. doi: 10.1007/s00266-018-1198-7. Epub 2018 Jul 20.
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.
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.
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.
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.
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资深作者（B.G.）在其面部美学实践中观察到，许多出现水平前额纹的患者也表现出上睑下垂或有足够的睑皮松弛需要矫正。本研究旨在调查这一观察结果。
对前来进行面部年轻化治疗的患者照片进行回顾性分析，以确定是否存在前额纹、上睑下垂、眉下垂和睑皮松弛。记录患者的年龄、性别和种族。仅纳入年龄超过50岁的患者。排除曾接受过眼睑或前额手术、先天性异常或创伤后畸形的患者。上睑下垂定义为上睑与虹膜重叠超过1.5毫米。根据是否存在前额纹将患者分为两组进行比较分析。
共纳入160例患者，其中有水平前额纹的患者100例，无水平前额纹的患者60例。有前额纹的患者年龄可能更大（61.56±8.93岁 vs. 58.58±7.59岁；P = 0.0337），男性比例更高（36% vs. 11.67%；P = 0.0008），上睑下垂发生率更高（90% vs. 76.67%；P = 0.0377），睑皮松弛发生率更高（20% vs. 5%；P = 0.0097）。所有28例单侧前额纹患者（17例左侧，11例右侧）均有同侧上睑下垂。
上睑下垂和睑皮松弛可能通过额肌代偿性激活导致水平前额纹的出现。每当发现水平前额皱纹时，必须在静息状态下检查是否存在上睑下垂或睑皮松弛。否则，前额年轻化可能无法消除这些代偿性前额纹，而化学去神经支配可能会通过强行阻断额肌代偿对视野产生重大不良影响。
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