Purpose

The most challenging scenario in upper blepharoplasty is an association with low upper orbital rim and low brow with enophthalmos resulting in overlap of the eyelid by the brow.
This is common in men, the brow does not droop but there is a very narrow space between the globe and the orbital rim, and the eyelashes are covered by an heavy brow.
Skin excision alone will not yield a substantial cosmetic improvement.
We describe a technique involving ROOF volume reduction associated with the reconnection of the skin to the levator aponeurosis at the right level to recreate a lid crease above the lash line.

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Methods

This technique is indicated in patients with an eyebrow normally positioned in front of the upper orbital rim where this rim lies very close to the globe.
The incision is made 9 mm above the lash line; the excess skin is removed as for a traditional blepharoplasty; the orbicularis is dissected from the levator aponeurosis
and then from the septum. The septum is opened, and the volume of the orbital fat is reduced if it is excessive.
The ROOF is then separated from the orbital septum posteriorly and from the orbicularis anteriorly, then is partially reduced in volume to decrease its height.
The lid crease is then recreated by cutaneous stitches engaging the aponeurosis at the level of the upper edge of the tarsus.

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Results

This technique reduces the prominence of the eyebrow and produces a spectacular eye opening effect.

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Conclusion

In the absence of true brow ptosis but with a naturally heavy and low brow, normally positioned in front of the upper orbital rim, a ROOF reduction achieves a spectacular improvement in superior blepharoplasty result.

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Additional Authors

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