Developed Lower-Positioned Transverse Ligament Restricts Eyelid Opening and Folding and Determines Japanese as Being With or Without Visible Superior Palpebral Crease

Midori Ban, MD; Kiyoshi Matsuo, MD, PhD; Ryokuya Ban, MD, PhD; Shunsuke Yuzuriha, MD, PhD; and Ai Kaneko, MD

Disclosures

ePlasty. 2013;13 

In This Article

Subjects and Methods

We enrolled 66 Japanese subjects (53 women and 13 men, aged 18–79 years). Reasons for the surgery consisted of 10 blepharoplasties, 18 bilateral acquired blepharoptoses, and 5 unilateral congenital blepharoptoses in 33 subjects without visible SPC, and 8 blepharoplasties and 25 bilateral acquired blepharoptoses in 33 subjects with visible natural SPC. The nonptotic eyelids in 5 subjects with unilateral blepharoptosis were evaluated.

We first evaluated whether digital immobilization of eyebrow movement by pressing on the anterior surface of the supraorbital margin, during movement from loosely closed eyelids following tight eyelid closure with relaxing the frontalis muscle[23] to eyelid opening for primary gaze, restricted eyelid opening in both groups (Figs 2c, 3b, 4b, and 5b). A pupillary center that was not exposed under digital immobilization was judged to be restricted, while one that was exposed was judged as unrestricted.

Figure 3.

An 18-year-old woman without visible SPC being treated for blepharoplasty. (a) Primary gaze. (b) Digital immobilization of eyebrow movement completely restricts opening and folding of both eyelids. (c) Arrow indicates 1 thick LTL behind the orbital septum. Abbreviations are explained in the caption of Figure 1.

Figure 4.

A 59-year-old woman with visible SPC suffering from left acquired blepharoptosis owing to the use of unilateral contact lens for 40 years. (a) Primary gaze. (b) Digital immobilization of eyebrow movement does not restrict opening and folding of either eyelid. (c) Arrow indicates a thin LTL. APO indicates aponeurosis. Other abbreviations are explained in the caption of Figure 1.

Figure 5.

A 45-year-old woman with visible SPC suffering from bilateral acquired blepharoptosis owing to the use of bilateral contact lens for 27 years. (a) Bilateral eyebrow are lifted by compensatory reflex contraction of the frontalis muscles in primary gaze. (b) Digital immobilization of the eyebrow movement slightly restricts opening of eyelids but does not restrict folding of eyelids. (c) An arrow indicates a thin LTL. APO indicates aponeurosis. Other abbreviations are explained in the caption of Figure 1.

Intraoperatively, LTLs in the lower orbital fat space were analyzed in terms of size and variation based on an attached 10-mm2 square scale (Casmatch; Dai Nippon Printing Co, Ltd, Tokyo, Japan) and the size of retractors or forceps (Figs 2d, 2e, 3c, 4c, 5c, and 6). The width of the lowest LTL in each subject was measured for statistical comparisons of both group subjects without and with visible SPC (Fig 7). Three representative LTLs in each group that were resected for surgical purposes were subjected to Azan staining for histological analysis (Fig 8).

Figure 6.

Variations in numbers of LTLs in subjects without or with SPC. Abbreviations are explained in the caption of Figure 1.

Figure 7.

Difference in width of the lowest LTL between subjects without and with visible SPC. Abbreviations are explained in the caption of Figure 1.

Figure 8.

Azan-stained sagittal sections of surgically discarded tissues that include LTL in representative subjects without (a) or with (b) SPC. Green arrows indicate LTLs. OOM indicates orbicularis oculi muscle. Other abbreviations are explained in the caption of Figure 1.

All subjects gave informed consent to participate in this study, which was approved by our institutional review board for human subjects. Statistical analysis was performed using the Student t test. P < .05 was used to indicate statistical significance.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....