Rethinking Upper Blepharoplasty: The Impact of Pretarsal Show.

Area of Science:

• Oculoplastic surgery
• Facial plastic surgery
• Cosmetic surgery

Background:

• Conventional upper blepharoplasty involves skin, muscle, and fat excision to achieve optimal eyelid aesthetics.
• Identifying patient-specific topographic features is crucial for predicting cosmetic outcomes.
• Pretarsal show, the visibility of the pretarsal orbicularis muscle, is a key feature evaluated.

Purpose of the Study:

• To identify presenting topographic features in upper blepharoplasty patients.
• To evaluate the impact of these features on cosmetic outcomes after surgery.

Main Methods:

• Retrospective review of 316 patients undergoing upper blepharoplasty (1997-2017).
• Standardized preoperative and postoperative photographs analyzed for pretarsal and upper lid fold heights.
• Patients categorized by preoperative pretarsal show (none, partial, complete) and aesthetic scores assigned by independent reviewers.

Main Results:

• Mean cosmetic score improved postoperatively (1.75 to 2.38).
• Patients with complete pretarsal show (Group 3) had significantly lower cosmetic score improvement compared to Groups 1 and 2.
• In Group 3, pretarsal heights >4 mm correlated with significantly lower aesthetic scores.

Conclusions:

• A significant portion of upper blepharoplasty patients present with complete pretarsal show, risking suboptimal results with conventional techniques.
• Adjunctive procedures like fat grafting and ptosis repair may enhance outcomes for patients with complete pretarsal show.
• Preoperative assessment of pretarsal show is vital for surgical planning and patient counseling.