Outcomes of Upper Eyelid Skin Excision Via the Subbrow Approach With Suspension of the Orbicularis Oculi Musculocutaneous Flap to the Frontalis Muscle

Abstract

Objective:

To evaluate the outcomes of upper eyelid skin excision via the subbrow approach combined with suspension of the orbicularis oculi musculocutaneous flap to the frontalis muscle.

Materials and Methods:

A prospective descriptive case series was conducted involving 30 patients (60 eyelid-brow units) who underwent surgery at the Department of Plastic and Aesthetic Surgery, Cho Ray Hospital, from February to August 2024. Preoperative and postoperative assessments were conducted at 1 month and 3 months. Key variables included the distance from a horizontal plane through the mid-pupil to the upper eyelid skin crease and to the superior eyebrow margin at 3 measurement points. Postoperative pain was evaluated using the Visual Analog Scale (VAS), and patient satisfaction was assessed using the Likert scale.

Results:

The mean age was 54.4 years (range: 35-70). The height of the upper eyelid crease increased significantly at the mid-pupil and lateral canthal regions at both 1 month and 3 months postoperatively (P < .0001), while the position of the eyebrow did not show any statistically significant change (P > .05). Most patients experienced no pain or only mild postoperative pain. Transient symptoms such as nausea and forehead numbness were noted but resolved completely. Subbrow scars were esthetically acceptable in all cases. The satisfaction rate was high, with 93.3% satisfaction at 1 month and 86.7% at 3 months.

Conclusion:

Upper eyelid skin excision via the subbrow approach combined with suspension of the orbicularis oculi musculocutaneous flap to the frontalis muscle is a safe and effective technique that significantly improves upper eyelid skin redundancy without altering the position of the eyebrow. The procedure is associated with minimal postoperative pain and high patient satisfaction.