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


ePlasty. 2013;13 

In This Article


Digital immobilization of eyebrow movement restricted eyelid opening in all 33 subjects without visible SPC (Figs 2c and 3b) but did not restrict in any subject with visible SPC, even in those with acquired blepharoptosis (Figs 4b and 5b).

Lower-positioned transverse ligaments behind the lower orbital septum consisted of 1 thick LTL in 23 (Fig 3c) and 2 or more thick LTLs in 10 (Fig 2e) of the 33 subjects without visible SPC. Lower-positioned transverse ligaments consisted of 1 thin LTL in 18 (Figs 4c and 5c) and 2 or more thin LTLs in 13 of the 33 subjects with visible SPC (Fig 6) and were undetectable in 2 subjects in this group.

The mean width of the lowest LTL behind the lower orbital septum in the nonvisible SPC group (1.15 ± 0.44 mm) was significantly larger than that in the visible SPC group (0.88 ± 0.45 mm) (P = 0.0136) (Fig 7).

Histological examination confirmed our macroscopic findings, whereby collagen fibers of the LTL in subjects without visible SPC (Fig 8a) appeared to be thicker than those in subjects with visible SPC (Fig 8b).