Does every dermatochalasis require blepharoplasty?
Author: Blanka Doko Mandic
Base Hospital / Institution: University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia
ePoster presentation
Abstract ID: 25-580
Purpose
To determine the proportion of patients referred for upper blepharoplasty who have
dermatochalasis secondary to unrecognized brow ptosis.
Methods
We analyzed 47 consecutive patients referred with clinically significant dermatochalasis. All
underwent visual field testing, confirming superior quadrant constriction. Brow position
was measured from the Frankfurt horizontal line using a precision ruler. Ptosis was
classified as: Normal (≥18 mm), Grade I (17–15 mm), Grade II (14–12 mm), Grade III (11–9
mm), and Grade IV (≤8 mm). Patients were informed about the difference between true dermatochalasis and brow ptosis as the underlying cause. Informed consent was obtained for corrective supraciliary brow lift in all cases where indicated.
Additionally, a second group of patients who had previously undergone brow lift surgery at our institution was evaluated using POSAS 3.0 scar assessment questionnaire.
Results
61.7% of patients had brow ptosis (Grade II–IV) as the primary cause of
dermatochalasis. Despite this, all had been referred for blepharoplasty alone. After explanation, all eligible patients consented to supraciliary brow lift surgery.
In the second group of previously operated patients, POSAS 3.o scar assessment showed that most scars were rated as not or minimally different in terms of pigmentation, texture, vascularity, surface level, firmness, adherence and tension. Scar widening was absent in 25/30 cases and no patients reported visible closure marks.
Conclusion
Failure to assess the brow and forehead leads to misdiagnosis and inappropriate surgical
planning, resulting in suboptimal functional and aesthetic results. Supraciliary scars are
well tolerated and should not deter appropriate surgical correction.
Not all dermatochalasis cases require blepharoplasty. Brow position must be evaluated
first, and in many cases corrected before or alongside eyelid surgery.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Jelena | Škunca Herman | University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia |
| Ivan | Jerković | University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia |
| Ognjen | Zrinšćak | University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia |
| Renata | Iveković | University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia |
| Zoran | Vatavuk | University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Zagreb, Croatia |
