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Periorbital and Orbital Aging: Senile Enophthalmos as a Cause of Upper Eyelid Ptosis

Guyuron, Bahman, M.D.; Harvey, Donald, M.D.

Plastic and Reconstructive Surgery: July 2016 - Volume 138 - Issue 1 - p 31e-37e
doi: 10.1097/PRS.0000000000002264
Cosmetic: Original Articles

Background: The aim of this study was to assess the effects of orbital aging over a prolonged period.

Methods: The orbit and periorbital region were assessed in 21 adult patients over 6 to 24 years with medical-quality facial photographs. The anteroposterior and lateral photographs were evaluated for orbital changes, including enophthalmos and upper eyelid position. Quantitative analysis was performed on the anteroposterior photographs, and qualitative analysis was used to assess enophthalmos.

Results: The mean age of the patients was 40 years at initial photography and 57 years at the time of secondary photography. At initial photography, eight of the 21 patients had ptosis: six had bilateral mild ptosis (<2 mm), one had bilateral moderate (2 to 3 mm) ptosis, and one had unilateral mild ptosis. At the second time point, only two patients did not have ptosis: four had unilateral mild, seven had bilateral mild, and eight had bilateral moderate ptosis. One patient had unilateral and two patients had bilateral enophthalmos at the initial photography. Nineteen of the 21 patients had relative enophthalmos at the second time point, and all 19 of the patients had eyelid ptosis (p < 0.00001).

Conclusions: This study demonstrates the development of age-related enophthalmos and eyelid ptosis and the strong association between age-related enophthalmos and upper eyelid ptosis, which is commonly undetected.

Cleveland, Ohio

From the Department of Plastic Surgery, Case School of Medicine; and the Department of Plastic Surgery, University Hospital Case Medical Center.

Received for publication February 23, 2015; accepted February 18, 2016.

Disclosure:Dr. Guyuron receives royalties for Plastic Surgery Indications and Practice, Atlas of Aesthetic Surgery, the Rhinoplasty books from Elsevier, and is the majority shareholder at Innovative Medical Equipment, LLC (Cleveland, Ohio). Dr. Harvey has no disclosures.

Bahman Guyuron, M.D., 29017 Cedar Road, Lyndhurst, Ohio 44124,

Copyright © 2016 by the American Society of Plastic Surgeons