Curve Analysis of the Aging Orbital Aperture

One can objectively describe a youthful orbit. Figure 1 presents measurements of orbital structures found in young women.1-3 These measurements include the dimensions and cant of the palpebral fissure, the distance of the eyebrow from the midpupil, the height of the lower lid, and the projection of the cheek beyond the cornea. These dimensions and relations, which are characteristic of the youthful orbit, have been summarized as follows: brows with an apex lateral slant, eyes that are narrow, lower lids that are short, and cheeks that are full.4 These attributes should be the goal of orbital contour rejuvenation. As commonly performed, orbital rejuvenation surgery usually fails to restore youthful orbital contours; rather, it alters these contours, often exaggerating those of aging (Fig. 2).

In a recent article reviewing the 2001 meeting of the American Society for Aesthetic Plastic Surgery, Rohrich5 points out that the specialty of plastic surgery has evolved beyond just technique. The meeting’s emphasis was placed on mastering shape and contour to restore and enhance. Rohrich asks, “Do we restore patients to appear younger and better or to look different?” He points out that youthful brows, upper and lower lids, cheeks, and midfaces are full. Defining the attributes of youth and those of aging is a critical first step in developing techniques for effective facial rejuvenation. Figure3 shows pre-operative and postoperative views of the left orbit of a woman whose rejuvenative orbital surgery attempted to restore the attributes of youth previously defined1,2 and demonstrated in Figure 1.

Although mathematical analysis can provide normative data that can objectively define changes that occur with aging, it is unlikely that curve analysis and recognition of particular curve forms on the human face can help understand the subjective attributes of human attractiveness or can guide the aesthetic surgeon6 in the creation of a beautiful face. Farkas et al.7 found little validity to the mathematically based neoclassical and Renaissance canons when those standards were applied to living, attractive faces.

FIG. 1. Mean dimensions of a young female orbit as pre¬viously determined.1-3 Frontal view (left). The mean height of the palpebral fissure.at the.midpupil (ps to p') is 11 mm. The mean width (MC to LQ is 31 mm. The mean inclination of the lateral can thus relative to the medial canthi is +4 degrees. The mean distance between the lower pordon of the brow and the midpupil is 21 mm. Lateral view (right). The cheek projects 1.5 mm beyond the cornea in the sagittal plane.
FIG. 1. Mean dimensions of a young female orbit as previously determined.1-3 Frontal view (left). The mean height of the palpebral fissure at the midpupil (ps to p’) is 11 mm. The mean width (MC to LQ is 31 mm. The mean inclination of the lateral can thus relative to the medial canthi is +4 degrees. The mean distance between the lower pordon of the brow and the midpupil is 21 mm. Lateral view (right). The cheek projects 1.5 mm beyond the cornea in the sagittal plane.

Etcoff8 has pointed out that although the mathemat­ical ratio phi, equal to 1.1618 and known as the divine proportion, may be seen in many biologic forms and its approximation may characterize certain relations of the normal human face,9 it does not distinguish beauti­ful from average or beautiful from plain. Etcoff summarizes her analysis of mathemat­ical ideals of human beauty and, in effect, her entire book, which is subtitled The Science of Beauty, by saying that, “For scientists in this century, the key to understanding human beauty is in our biology not in mathematics.”

Fig. 2. Frontal (left) and lateral (right) views of a 60-year-old woman who has undergone conventional upper and lower lid blepharoplasty as well as rhytidectomy. Note that aggressive skin, muscle, and fat removal has distorted the palpebral fissure, producing a “round eye” appearance and unmasking the aging-related superomedial and inferolateral orbit aperture, changes demonstrated in the article being discussed. On lateral view, the eye appears proptotic, and the cheek lies well behind the cornea. This cosmetic surgery, intended to be rejuvenative, has produced an appearance that has no similarity to the orbit shown in Figure 1 (above) of Pessa and Yuan’s article and Figure 1 of this discussion. It has made the patient look different, if not older.
Fig. 2. Frontal (left) and lateral (right) views of a 60-year-old woman who has undergone conventional upper and lower lid blepharoplasty as well as rhytidectomy. Note that aggressive skin, muscle, and fat removal has distorted the palpebral fissure, producing a “round eye” appearance and unmasking the aging-related superomedial and inferolateral orbit aperture, changes demonstrated in the article being discussed. On lateral view, the eye appears proptotic, and the cheek lies well behind the cornea. This cosmetic surgery, intended to be rejuvenative, has produced an appearance that has no similarity to the orbit shown in Figure 1 (above) of Pessa and Yuan’s article and Figure 1 of this discussion. It has made the patient look different, if not older.
FIG. 3. The preoperative and postoperative appearance of a 48-year-olcl woman who underwent rejuvenative orbital surgery attempting to restore the attributes of youth previously defined by Pessa et al.2 and Farkas3 and demonstrated in Figure 1. A subperiosteal brow and midface lift, conservative upper lid. and skin-only lower lid blepharoplasty1 were performed.
FIG. 3. The preoperative and postoperative appearance of a 48-year-old woman who underwent rejuvenative orbital surgery attempting to restore the attributes of youth previously defined by Pessa et al.2 and Farkas3 and demonstrated in Figure 1. A subperiosteal brow and midface lift, conservative upper lid. and skin-only lower lid blepharoplasty1 were performed.
22, March, 2016admin