Comparison of Brow Lifting Techniques with Correlation to Dry Eye Syndrome and Lagophthalmos

Abstract

Purpose: Ptotic brows are a common functional diagnosis as involutional changes from genetics, gravity, and aging alter the aesthetically pleasing position of brows. The direct brow lift (DBL) and internal browpexy (IB) are procedures employed to treat brow ptosis. Brow lifts (BL) and blepharoplasties (B) are often done as combinant procedures, as brow ptosis can exacerbate the superior and lateral visual field loss caused by dermatochalasis. Dry eye syndrome (DES) and lagophthalmos (LO) are known side effects of B but there is currently no published literature that assesses the occurrence of these effects with BL alone or in combination with B procedures. This study seeks to assess the following variables: 1. If BL effect the incidence of postoperative DES; 2. If BL effect the incidence of postoperative LO; 3. If BL effect the amount of skin removed when a combinant B is performed.

Methods: A retrospective review of patients undergoing a DBL alone, DBL plus B, and IB plus B. Patient charts were reviewed for preoperative presence of DES or LO and then at the final postoperative visit. Those patients who underwent combinant B had the amount of lid skin removed recorded in the chart. An unpaired t-test was used to compare amount of skin removal in DBL alone and DBL plus B. Fisher’s exact test was used to compare DES and LO in DBL alone to DBL/B and IB/B.

Results: Seventy patients (136 eyes), 36 males and 34 females, were included in the study. The average patient age was 69.3 (9.5 std D). There was no statistically significant difference in the amount of brow skin removed whether a DBL alone was performed or in combination with B (p=0.7; CI -0.8 to 1.2). There was no statistically significant difference between DES in DBL alone and DBL/B (p=1.0) or DBL alone and IB/B (p=1.0) and between the incidence of LO in DBL alone and DBL/B (p=1.0) or DBL alone and IB/B (p=1.0). The findings showed a low incidence of DES (2.4%) and LO (1.5%) in our patient population treated with DBL alone, DBL/B, or IB/B.

Conclusions: Brow lifts did not alter the amount of eyelid skin removed in blepharoplasties. This supports the conclusion that these involutional processes require separate procedures for complete improvement of superior visual field loss as temporal brow skin can cause field loss even when dermatochalasis has been corrected. The findings showed a low incidence of postoperative DES and LO following BL alone or with B.

Keywords: 526 eyelid • 413 aging • 631 orbit