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J Cosmet Med 2017; 1(1): 16-24

Published online June 30, 2017

https://doi.org/10.25056/JCM.2017.1.1.16

Age-related eyelid changes

Jacqueline Mupas-Uy, MD, Yoshiyuki Kitaguchi, MD, PhD, Yasuhiro Takahashi, MD, PhD, Hirohiko Kakizaki, MD, PhD

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan

Correspondence to :
Hirohiko Kakizaki, Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
Tel: 81-561-62-3311, Fax: 81-561-76-0822, E-mail: cosme@d1.dion.ne.jp

Received: December 29, 2016; Revised: March 9, 2017; Accepted: May 21, 2017

© Korean Society of Korean Cosmetic Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aging is a natural process where changes occur in multiple tissues, resulting in aesthetic and functional effects. Aging eyelids lead to a tired or sleepy appearance. Progressive changes continue throughout life; these may eventually affect the ocular surface and cause visual impairment. Objective is to report the pathophysiology of the common age-related eyelid disorders and the current management concepts. This article presents the pathophysiology and the surgical procedures of eyelid disorders, such as blepharoptosis, dermatochalasis, entropion, ectropion, baggy eyelids, epicanthus, and lateral canthal aging. In general, most age-related eyelid changes are corrected due to its to its associated cosmetic and functional problems. Management is based on anatomic factors contributing to the eyelid disorder. Conclusion is the choice of surgical procedure is based on the exact localisation of the eyelid pathology.

Keywords: aging, eyelid, pathophysiology, disorder

  1. Pottier F, El-Shazly NZ, El-Shazly AE. Aging of orbicularis oculi: anatomophysiologic consideration in upper blepharoplasty. Arch Facial Plast Surg 2008;10:346-9.
    Pubmed CrossRef
  2. Oh SR, Chokthaweesak W, Annunziata CC, Priel A, Korn BS, Kikkawa DO. Analysis of eyelid fat pad changes with aging. Ophthal Plast Reconstr Surg 2011;27:348-51.
    Pubmed CrossRef
  3. Camp MC, Wong WW, Filip Z, Carter CS, Gupta SC. A quantitative analysis of periorbital aging with three-dimensional surface imaging. J Plast Reconstr Aesthet Surg 2011;64:148-54.
    Pubmed CrossRef
  4. Lee H, Lee JS, Chang M, Park M, Baek S. Analysis of lid contour change with aging in Asians by measuring midpupil lid distance. Plast Reconstr Surg 2014;134:521e-9e.
    Pubmed CrossRef
  5. Meyer DR, Linberg JV, Powell SR, Odom JV. Quantitating the superior visual field loss associated with ptosis. Arch Ophthalmol 1989;107:840-3.
    Pubmed CrossRef
  6. Watanabe A, Araki B, Noso K, Kakizaki H, Kinoshita S. Histopathology of blepharoptosis induced by prolonged hard contact lens wear. Am J Ophthalmol 2006;141:1092-6.
    Pubmed CrossRef
  7. Bailey AJ, Duance VC. Collagen in acquired connective tissue diseases: an active or passive role? Eur J Clin Invest 1980;10:13.
    CrossRef
  8. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin North Am 2005;38:921-46.
    Pubmed CrossRef
  9. Wada Y, Hashimoto T, Kakizaki H, Isogai N, Asamura S. What is the best way to handle the involutional blepharoptosis repair? J Craniofac Surg 2015;26:e377-80.
    Pubmed CrossRef
  10. Noma K, Takahashi Y, Leibovitch I, Kakizaki H. Transcutaneous blepharoptosis surgery: simultaneous advancement of the levator aponeurosis and Müller’s muscle (levator resection). Open Ophthalmol J 2010;4:71-5.
    Pubmed KoreaMed CrossRef
  11. DeAngelis DD, Carter SR, Seiff SR. Dermatochalasis. Int Ophthalmol Clin 2002;42:89-101.
    Pubmed CrossRef
  12. Nagi KS, Carlson JA, Wladis EJ. Histologic assessment of dermatochalasis:elastolysis and lymphostasis are fundamental and interrelated findings. Ophthalmology 2011;118:1205-10.
    Pubmed CrossRef
  13. Onizuka T. Operative plastic and aesthetic surgery. 3rd ed. Tokyo: Nankodo; 1996.
    KoreaMed
  14. van den Bosch WA, Leenders I, Mulder P. Topographic anatomy of the eyelids, and the effects of sex and age. Br J Ophthalmol 1999;83:347-52.
    Pubmed KoreaMed CrossRef
  15. Collin JR, Rathbun JE. Involutional entropion. A review with evaluation of a procedure. Arch Ophthalmol 1978;96:1058-64.
    CrossRef
  16. Kakizaki H, Malhotra R, Madge SN, Selva D. Lower eyelid anatomy: an update. Ann Plast Surg 2009;63:344-51.
    Pubmed CrossRef
  17. Kakizaki H, Zhao J, Nakano T, Asamoto K, Zako M, Iwaki M, et al. The lower eyelid retractor consists of definite double layers. Ophthalmology 2006;113:2346-50.
    Pubmed CrossRef
  18. Quickert MH, Rathbun E. Suture repair of entropion. Arch Ophthalmol 1971;85:304-5.
    CrossRef
  19. Lee H, Takahashi Y, Ichinose A, Kakizaki H. Comparison of surgical outcomes between simple posterior layer advancement of lower eyelid retractors and combination with a lateral tarsal strip procedure for involutional entropion in a Japanese population. Br J Ophthalmol 2014;98:1579-82.
    Pubmed CrossRef
  20. Kakizaki H, Zako M, Kinoshita S, Iwaki M. Posterior layer advancement of the lower eyelid retractor in involutional entropion repair. Ophthal Plast Reconstr Surg 2007;23:292-5.
    Pubmed CrossRef
  21. Ishida Y, Takahashi Y, Kakizaki H. Posterior layer advancement of lower eyelid retractors with transcanthal canthopexy for involutional lower eyelid entropion. Eye (Lond) 2016;30:1469-74.
    Pubmed CrossRef
  22. Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol 1979;97:2192-6.
    CrossRef
  23. Bick MW. Surgical management of orbital tarsal disparity. Arch Ophthalmol 1966;75:386-9.
    Pubmed CrossRef
  24. Georgescu D. Surgical preferences for lateral canthoplasty and canthopexy. Curr Opin Ophthalmol 2014;25:449-54.
    Pubmed CrossRef
  25. Higaki F, Noma K, Takahashi Y, Kakizaki H. A case of medial ectropion cured after canaliculoplasty and intubation. Orbit 2013;32:60-2.
    Pubmed CrossRef
  26. Olver JM, Sathia PJ, Wright M. Lower eyelid medial canthal tendon laxity grading: an interobserver study of normal subjects. Ophthalmology 2001;108:2321-5.
    CrossRef
  27. Nowinski TS, Anderson RL. The medial spindle procedure for involutional medial ectropion. Arch Ophthalmol 1985;103:1750-3.
    CrossRef
  28. Smith B. The ‘‘lazy-T’’ correction of ectropion of the lower punctum. Arch Ophthalmol 1976;94:1149-50.
    Pubmed CrossRef
  29. Anderson RL, Hatt MU, Dixon R. Medial ectropion. A new technique. Arch Ophthalmol 1979;97:521-4.
    Pubmed CrossRef
  30. Crawford GJ, Collin JR, Moriarty PA. The correction of paralytic medial ectropion. Br J Ophthalmol 1984;68:639-41.
    Pubmed KoreaMed CrossRef
  31. Kuhnt H, Jena G, Fischer. Beitrage zur Operationen augenheikunder. Jena: G Fischer; 1883. p. 44-55.
  32. Szymanowski J. Handbuch der Operationen Chirurgie. Berlin:Braunschweig; 1870. p. 243.
  33. Richard MJ, Morris C, Deen BF, Gray L, Woodward JA. Analysis of the anatomic changes of the aging facial skeleton using computer-assisted tomography. Ophthal Plast Reconstr Surg 2009;25:382-6.
    Pubmed CrossRef
  34. de la Plaza R, Arroyo JM. A new technique for the treatment of palpebral bags. Plast Reconstr Surg 1988;81:677-87.
    Pubmed CrossRef
  35. Maniglia JJ, Maniglia RF, Jorge dos Santos MC, Robert F, Maniglia FF, Maniglia SF. Surgical treatment of the sunken upper eyelid. Arch Facial Plast Surg 2006;8:269-72.
    Pubmed CrossRef
  36. Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016;137:196e-213e.
    Pubmed CrossRef
  37. Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 1995;96:35462.
    CrossRef
  38. Yoo WM, Park SH, Kwag DR. Root z-epicanthoplasty in asian eyelids. Plast Reconstr Surg 2002;109:2067-71; discussion 2072-3.
    Pubmed CrossRef
  39. Kakizaki H, Ichinose A, Nakano T, Asamoto K, Ikeda H. Anatomy of epicanthal fold. Plast Reconstr Surg 2012;130: 494e-5e.
    Pubmed CrossRef

Article

Review Article

J Cosmet Med 2017; 1(1): 16-24

Published online June 30, 2017 https://doi.org/10.25056/JCM.2017.1.1.16

Copyright © Korean Society of Korean Cosmetic Surgery.

Age-related eyelid changes

Jacqueline Mupas-Uy, MD, Yoshiyuki Kitaguchi, MD, PhD, Yasuhiro Takahashi, MD, PhD, Hirohiko Kakizaki, MD, PhD

Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan

Correspondence to:Hirohiko Kakizaki, Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, 1-1 Yazako-Karimata, Nagakute, Aichi 480-1195, Japan
Tel: 81-561-62-3311, Fax: 81-561-76-0822, E-mail: cosme@d1.dion.ne.jp

Received: December 29, 2016; Revised: March 9, 2017; Accepted: May 21, 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Aging is a natural process where changes occur in multiple tissues, resulting in aesthetic and functional effects. Aging eyelids lead to a tired or sleepy appearance. Progressive changes continue throughout life; these may eventually affect the ocular surface and cause visual impairment. Objective is to report the pathophysiology of the common age-related eyelid disorders and the current management concepts. This article presents the pathophysiology and the surgical procedures of eyelid disorders, such as blepharoptosis, dermatochalasis, entropion, ectropion, baggy eyelids, epicanthus, and lateral canthal aging. In general, most age-related eyelid changes are corrected due to its to its associated cosmetic and functional problems. Management is based on anatomic factors contributing to the eyelid disorder. Conclusion is the choice of surgical procedure is based on the exact localisation of the eyelid pathology.

Keywords: aging, eyelid, pathophysiology, disorder

References

  1. Pottier F, El-Shazly NZ, El-Shazly AE. Aging of orbicularis oculi: anatomophysiologic consideration in upper blepharoplasty. Arch Facial Plast Surg 2008;10:346-9.
    Pubmed CrossRef
  2. Oh SR, Chokthaweesak W, Annunziata CC, Priel A, Korn BS, Kikkawa DO. Analysis of eyelid fat pad changes with aging. Ophthal Plast Reconstr Surg 2011;27:348-51.
    Pubmed CrossRef
  3. Camp MC, Wong WW, Filip Z, Carter CS, Gupta SC. A quantitative analysis of periorbital aging with three-dimensional surface imaging. J Plast Reconstr Aesthet Surg 2011;64:148-54.
    Pubmed CrossRef
  4. Lee H, Lee JS, Chang M, Park M, Baek S. Analysis of lid contour change with aging in Asians by measuring midpupil lid distance. Plast Reconstr Surg 2014;134:521e-9e.
    Pubmed CrossRef
  5. Meyer DR, Linberg JV, Powell SR, Odom JV. Quantitating the superior visual field loss associated with ptosis. Arch Ophthalmol 1989;107:840-3.
    Pubmed CrossRef
  6. Watanabe A, Araki B, Noso K, Kakizaki H, Kinoshita S. Histopathology of blepharoptosis induced by prolonged hard contact lens wear. Am J Ophthalmol 2006;141:1092-6.
    Pubmed CrossRef
  7. Bailey AJ, Duance VC. Collagen in acquired connective tissue diseases: an active or passive role? Eur J Clin Invest 1980;10:13.
    CrossRef
  8. Edmonson BC, Wulc AE. Ptosis evaluation and management. Otolaryngol Clin North Am 2005;38:921-46.
    Pubmed CrossRef
  9. Wada Y, Hashimoto T, Kakizaki H, Isogai N, Asamura S. What is the best way to handle the involutional blepharoptosis repair? J Craniofac Surg 2015;26:e377-80.
    Pubmed CrossRef
  10. Noma K, Takahashi Y, Leibovitch I, Kakizaki H. Transcutaneous blepharoptosis surgery: simultaneous advancement of the levator aponeurosis and Müller’s muscle (levator resection). Open Ophthalmol J 2010;4:71-5.
    Pubmed KoreaMed CrossRef
  11. DeAngelis DD, Carter SR, Seiff SR. Dermatochalasis. Int Ophthalmol Clin 2002;42:89-101.
    Pubmed CrossRef
  12. Nagi KS, Carlson JA, Wladis EJ. Histologic assessment of dermatochalasis:elastolysis and lymphostasis are fundamental and interrelated findings. Ophthalmology 2011;118:1205-10.
    Pubmed CrossRef
  13. Onizuka T. Operative plastic and aesthetic surgery. 3rd ed. Tokyo: Nankodo; 1996.
    KoreaMed
  14. van den Bosch WA, Leenders I, Mulder P. Topographic anatomy of the eyelids, and the effects of sex and age. Br J Ophthalmol 1999;83:347-52.
    Pubmed KoreaMed CrossRef
  15. Collin JR, Rathbun JE. Involutional entropion. A review with evaluation of a procedure. Arch Ophthalmol 1978;96:1058-64.
    CrossRef
  16. Kakizaki H, Malhotra R, Madge SN, Selva D. Lower eyelid anatomy: an update. Ann Plast Surg 2009;63:344-51.
    Pubmed CrossRef
  17. Kakizaki H, Zhao J, Nakano T, Asamoto K, Zako M, Iwaki M, et al. The lower eyelid retractor consists of definite double layers. Ophthalmology 2006;113:2346-50.
    Pubmed CrossRef
  18. Quickert MH, Rathbun E. Suture repair of entropion. Arch Ophthalmol 1971;85:304-5.
    CrossRef
  19. Lee H, Takahashi Y, Ichinose A, Kakizaki H. Comparison of surgical outcomes between simple posterior layer advancement of lower eyelid retractors and combination with a lateral tarsal strip procedure for involutional entropion in a Japanese population. Br J Ophthalmol 2014;98:1579-82.
    Pubmed CrossRef
  20. Kakizaki H, Zako M, Kinoshita S, Iwaki M. Posterior layer advancement of the lower eyelid retractor in involutional entropion repair. Ophthal Plast Reconstr Surg 2007;23:292-5.
    Pubmed CrossRef
  21. Ishida Y, Takahashi Y, Kakizaki H. Posterior layer advancement of lower eyelid retractors with transcanthal canthopexy for involutional lower eyelid entropion. Eye (Lond) 2016;30:1469-74.
    Pubmed CrossRef
  22. Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol 1979;97:2192-6.
    CrossRef
  23. Bick MW. Surgical management of orbital tarsal disparity. Arch Ophthalmol 1966;75:386-9.
    Pubmed CrossRef
  24. Georgescu D. Surgical preferences for lateral canthoplasty and canthopexy. Curr Opin Ophthalmol 2014;25:449-54.
    Pubmed CrossRef
  25. Higaki F, Noma K, Takahashi Y, Kakizaki H. A case of medial ectropion cured after canaliculoplasty and intubation. Orbit 2013;32:60-2.
    Pubmed CrossRef
  26. Olver JM, Sathia PJ, Wright M. Lower eyelid medial canthal tendon laxity grading: an interobserver study of normal subjects. Ophthalmology 2001;108:2321-5.
    CrossRef
  27. Nowinski TS, Anderson RL. The medial spindle procedure for involutional medial ectropion. Arch Ophthalmol 1985;103:1750-3.
    CrossRef
  28. Smith B. The ‘‘lazy-T’’ correction of ectropion of the lower punctum. Arch Ophthalmol 1976;94:1149-50.
    Pubmed CrossRef
  29. Anderson RL, Hatt MU, Dixon R. Medial ectropion. A new technique. Arch Ophthalmol 1979;97:521-4.
    Pubmed CrossRef
  30. Crawford GJ, Collin JR, Moriarty PA. The correction of paralytic medial ectropion. Br J Ophthalmol 1984;68:639-41.
    Pubmed KoreaMed CrossRef
  31. Kuhnt H, Jena G, Fischer. Beitrage zur Operationen augenheikunder. Jena: G Fischer; 1883. p. 44-55.
  32. Szymanowski J. Handbuch der Operationen Chirurgie. Berlin:Braunschweig; 1870. p. 243.
  33. Richard MJ, Morris C, Deen BF, Gray L, Woodward JA. Analysis of the anatomic changes of the aging facial skeleton using computer-assisted tomography. Ophthal Plast Reconstr Surg 2009;25:382-6.
    Pubmed CrossRef
  34. de la Plaza R, Arroyo JM. A new technique for the treatment of palpebral bags. Plast Reconstr Surg 1988;81:677-87.
    Pubmed CrossRef
  35. Maniglia JJ, Maniglia RF, Jorge dos Santos MC, Robert F, Maniglia FF, Maniglia SF. Surgical treatment of the sunken upper eyelid. Arch Facial Plast Surg 2006;8:269-72.
    Pubmed CrossRef
  36. Zoumalan CI, Roostaeian J. Simplifying blepharoplasty. Plast Reconstr Surg 2016;137:196e-213e.
    Pubmed CrossRef
  37. Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg 1995;96:35462.
    CrossRef
  38. Yoo WM, Park SH, Kwag DR. Root z-epicanthoplasty in asian eyelids. Plast Reconstr Surg 2002;109:2067-71; discussion 2072-3.
    Pubmed CrossRef
  39. Kakizaki H, Ichinose A, Nakano T, Asamoto K, Ikeda H. Anatomy of epicanthal fold. Plast Reconstr Surg 2012;130: 494e-5e.
    Pubmed CrossRef

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