Brow Height Research Articles

Quantitative Evaluation of the Effects of Blepharoplasty on Visual Field, Corneal Changes, and Cosmetic Appearance.

Blepharoplasty is an important eyelid surgical procedure, involving aesthetic and functional changes to the eyelids. The aim of this study is to investigate the effects of upper eyelid blepharoplasty on changes in the visual field, corneal changes, and cosmetic appearance. This study was performed with preoperative and postoperative facial photographs of 32 patients who underwent bilateral blepharoplasty. Marginal reflex distance (MRD1), percentage of corneal exposure area (CEA), and brow height (BH) were obtained from photographs. intraocular pressure (IOP) and ocular biometric parameters were also obtained. The morphometric and ocular parameters obtained from preoperative, postoperative first-month, and postoperative third-month patients were compared using repeated measures ANOVA test. Significant differences in MRD1, CEA, and BH were observed between preoperative, postoperative first-month, and postoperative third-month patients. Improvements were observed in left axis and right corneal astigmatism axis measurements in the postoperative third month compared with preoperative measurements, and the positive change was statistically significant (P=0.020, P=0.036). Upper eyelid blepharoplasty could provide satisfactory functional and aesthetic outcomes by contributing to the improvement of pseudoptosis and reduction in eyebrow height postoperatively.

Vertıcal Internal Brow Suspensıon: A Technıque to Avoıd Lateral Relapse After Endoscopıc Brow Lıft.

Endoscopic brow lift is an integral component of upper face surgical rejuvenation protocols. Lateral relapse is one of the leading causes of dissatisfaction after endoscopic brow lift. This study introduces and evaluates the Vertical Internal Brow Suspension (VIBS), a novel fixation technique designed to prevent lateral brow relapse following endoscopic brow lifts. A retrospective review was conducted on 118 consecutive endoscopic brow lift cases performed by the author between January 2019 and June 2024, using the VIBS technique. Additionally a subgroup of 29 patients who underwent isolated endoscopic brow lifts, with at least one year of follow-up, were included in a quantitative analysis of long-term brow position and forehead height. Significant increases in brow height across all measurement levels (P<0.001) were observed in the quantitative analysis subgroup. No significant change in forehead height was noted (P=0.927). The VIBS technique also beneficially reduced apparent forehead height in patients with initially high foreheads. Frontal suture extrusions (6.8%) and temporary hairloss around scalp incisions (5.1%) were the most common complications observed from the retrospective analysis of 118 patients. The VIBS technique effectively prevents lateral brow relapse, achieving stable lateral brow elevation. It is a safe technique with minor complications. It addresses one of the longstanding challenges of the endoscopic brow lift surgery, representing a valuable advancement in upper face rejuvenation procedures.

Change in Brow Position After Upper Blepharoplasty With or Without Internal Browpexy.

Only upper blepharoplasty can cause a change in the eyebrow position, so browpexy can be combined with blepharoplasty in selected patients. There are many brow lifting techniques, both surgical and nonsurgical, and internal browpexy is one of the most widely used surgical brow lifting techniques. The purpose of this study was to evaluate the change in brow position after upper blepharoplasty with or without internal browpexy using preoperative and postoperative photographs. Patients who underwent upper blepharoplasty by a single surgeon at Dokuz Eylul University Hospital between 2018 and 2022 were retrospectively evaluated. A total of 48 patients, 30 of whom underwent upper blepharoplasty only and 18 of whom underwent upper blepharoplasty combined with internal browpexy, were examined to present the change in brow position postoperatively. Preoperative and postoperative photographs were analyzed using the ImageJ program and the proportional changes in brow height were shown. The first group, which only underwent upper blepharoplasty only, consisted of 30 patients (62.5%), all female; the second group, which underwent upper blepharoplasty and internal browpexy, consisted of 18 patients (37.5%), all female. The change at the midpupil level was determined as a 6.13% decrease in the first group and a 2.99% increase in the second group; at the brow peak level, this change was a 6.2% decrease in the 1st group and a 4.38% increase in the 2nd group. In cases of dermatochalasis, blepharoplasty alone can cause a shortening of the distance between the eyebrow and the upper eyelid groove and an unaesthetic appearance. Internal browpexy is an easy-to-apply technique that allows stabilization of the eyebrow after skin excision and a small amount of elevation.

Ultrasound rejuvenation for upper facial skin: A randomized blinded prospective study.

Growing demand for facial rejuvenation drives advancements in these therapies, including laser, radiofrequency, and focused ultrasound, alongside thermal stimulation adjuncts. These methods, known for stimulating collagen regeneration, skin tightening, and lifting, have gained popularity due to their minimal side effects, low trauma, and high safety, demonstrating favorable outcomes in clinical practice. We sought to assess the efficacy of ultrasound skin tightening for brow lift within the scope of a procedure addressing facial sagging across the entire face. Our aim was to explore a noninvasive method capable of effectively enhancing mild to moderate brow ptosis by tightening and lifting the skin in the upper facial region. This was a rater-blinded, prospective cohort study. The upper facial region of the participants was treated with the new device, micro-focused ultrasound (MFU), in model D3.0/D2.0/M3.0. Outcomes of brow lift were measured in comparison of pretreatment and posttreatment photographs and three-dimensional (3D) vector analysis. A total of 42 participants (37 females) were enrolled, with 2 participants withdrawing from the trial, resulting in 40 subjects who completed 180-day-follow-up and evaluation. 35 (87.5%) were deemed to have clinically significant brow elevation by two blinded assessors (experienced clinicians) at 180-day posttreatment (p < 0.01). The mean change in brow height after 90-day was 2.16 ± 0.63 mm at the frontal position (straight-ahead gaze) (p < 0.01). The 3D vector analysis reveals varying magnitudes of vector displacement in the upward and outward directions of the skin on the frontal region above the eyebrows. Focused ultrasound appears to be a safe and effective method for upper facial skin rejuvenation. A single focused ultrasound treatment on the forehead and temple areas resulted in an average brow elevation of 2.1 mm.

Dual-plane lift-and-hold technique for brow ptosis in young patients with facial paralysis

Direct browlift is useful but leaves a scar above the brow. We proposed a dual-plane browlift to avoid facial scarring while effectively resolving brow ptosis in young and young adult patients. Seven patients with facial palsy underwent dual-plane browlift between July 2018 and June 2022. The mean postoperative follow-up period was 31.9months. Skin resection at the hairline was combined with subcutaneous dissection down to the inferior margin of the brow to "lift" the brow. Fascia lata strips were fixed to the dermis just inferior to the eyebrow to "hold" the brow, and the strips were suspended upward through the subperiosteal tunnel and fixed to the periosteum. Brow height was compared before and after the procedure and with the contralateral side. The reported complications included slight hematoma at the recipient site, temporary difficulty in closing the eye, and seroma at the fascia donor site. The paralyzed side showed significant differences between the preoperative period and postoperative months (POM) 3, 6, and 12, but differences were not shown in the intervals between POM 3 and 6, 6 and 12, or 3 and 12. The difference in eyebrow height between the paralyzed and nonparalyzed sides was significant preoperatively but not at POM 3, 6, or 12. All scars matured well, and the fascia silhouette was not visible in the forehead region. Dual-plane browlift enables rigid suspension using the fascia lata and excises flaccid skin without leaving facial scars, yielding excellent cosmetic quality and stable long-term outcomes.

The Impact of Surgical and Nonsurgical Interventions on Overall Oral, Palpebral Fissure, and Brow Height Symmetry in a Patient with Facial Synkinesis

The Impact of Surgical and Nonsurgical Interventions on Overall Oral, Palpebral Fissure, and Brow Height Symmetry in a Patient with Facial Synkinesis

Changes in eyebrow position following blepharoptosis surgery

Background The position of the eyebrows is critical when planning blepharoptosis surgery. However, insufficient scholarly attention has been paid to the details of postoperative eyebrow height changes at each anatomical landmark. This study investigated the effect of blepharoptosis surgery on brow height and evaluated the change in brow position.Methods After a retrospective review of 247 patients, this study analyzed 53 patients (106 eyelids) who underwent levator and Müller’s complex advancement between March 2010 and January 2022. Brow heights were measured from the distance between the upper brow margin of each landmark and horizontal line of pupillary center on a digital photograph.Results The mean change of eyebrow lowering was 1.54 mm (P&lt;0.001) at the medial canthus, 1.29 mm (P&lt;0.001) at the medial limbus, 1.44 mm (P&lt;0.001) at the center of the pupil, 1.40 mm (P&lt;0.001) at the lateral limbus, 1.15 mm (P=0.001) at the lateral canthus, and 0.75 mm (P=0.021) at the lateral eyebrow end. The brow change was most prominent at medial canthus and least prominent at the lateral brow end. The preoperative brow position was only statistically significant factor predicting brow height descent after surgery according to multiple linear regression analysis (R&lt;sup&gt;2&lt;/sup&gt;=0.305, B=–0.375, P&lt;0.001).Conclusions The eyebrows lowered in most patients after blepharoptosis surgery. The preoperative brow position is the most important factor in predicting the change in brow height after blepharoptosis surgery.

Brow Lift Through The Upper Blepharoplasty Incision: Prospective Clinical Study.

Eyebrow tail ptosis is usually associated with dermatochalasis of the upper eyelid, and it is necessary to treat them together. For these associated procedures to be incorporated as a routine in upper eyelid surgeries, they should preferably be less invasive with consequent fewer complications. We describe a minimally invasive technique for the correction of mild-to-moderate eyebrow tail ptosis corrected together with superior dermatochalasis through the blepharoplasty incision. A phase 2 clinical trial was conducted from February 2020 to December 2021. A total of 50 patients underwent conventional upper blepharoplasty surgery associated with the proposed eyebrow lift technique: internal pexia in the periosteum, dissection, and posterior fixation of the orbicularis muscle to the arcus marginalis, removal of the lateral part of the orbicularis muscle, and loosening of the orbital retention ligament. Evaluation of the height of the eyebrow tail was performed with digital photography in the initial consultation and at 30-90 days postoperatively and analyzed with ImageJ software. Mean difference in brow height at 1-month and 3-month postoperative evaluations compared to the preoperative period was 3.45-3.33 mm, respectively. Our study demonstrated a minimally invasive surgical technique for the treatment of mild-to-moderate eyebrow ptosis with significant eyebrow tail lift results that remained stable during the study period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hi5 Protocol for the Use of Microfocused Ultrasound with Visualization.

Microfocused ultrasound with visualization (MFU-V) is used for lifting and tightening of facial tissues. Standard protocols are completed in a single session. Despite excellent outcomes, we identified several barriers of entry for a significant number of patients. Therefore, we devised an individualized pan-facial protocol that is delivered as a series of short, intense treatments to address these issues. We enrolled 12 participants with mild-to-moderate skin and fibromuscular laxity to receive one superficial and one deep pass per visit (average 280 lines). Qualitative improvements were rated by both patients and physicians at 6 or 10 months due to COVID-19 delays. Changes in the submentum and eyebrow heights were quantified. Ten patients (age range: 31-61 years) underwent an average of four MFU-V treatments. Two patients were excluded after massive weight gain. Skin and fibromuscular ptosis and overall soft tissue laxity improved in all patients. Mean brow height increased by 1.7 mm, whereas the mean submental lift was 78.7 mm2. All patients and treating physicians rated an improvement in appearance, whereas independent physicians rated improvements in 87% of cases. Four patients self-rated as "markedly improved." Pain was rated at up to 6.2 (out of 10). Although mask-wearing was mandatory, loss of elasticity, wrinkles, and skin roughness all improved. Superficial welts (n = 5), erythema (n = 3), tenderness (n = 3), and mild bruising (n = 2) occurred, but all resolved within a few days and no severe or permanent adverse events occurred. The Hi5 protocol was noninferior to standard single-session protocols and improved brow heights and submental lifting.

Comparison of the effectiveness and safety of the “endoscope-assisted polypropylene mesh lift” and “gliding brow lift” techniques for the treatment of lateral brow ptosis

There are many techniques used to treat lateral brow ptosis. This study compared two techniques that are used for lateral brow rejuvenation in terms of effectiveness and safety-namely, endoscope-assisted polypropylene mesh lift (EAML) and gliding brow lift (GBL). Eighty-six patients who underwent brow lift surgery between March 2018 and June 2020 were included in this retrospective study. Forty-four patients were operated on using the EAML technique, whereas 42 patients were operated on using the GBL technique. The measurement of defined distances in photographs was carried out using a software, and the Brow Positioning Grading Scale (BPGS) and Global Aesthetic Improvement Scale (GAIS) were applied in the pre and postoperative periods. The measurement results obtained in the postoperative period were better than those obtained in the preoperative period for both the techniques, whereas the results obtained at postoperative month 3 were found to be better than those obtained at month 12 (p<0.05). The results were similar between the measurements at postoperative months 3 and 12 for both the techniques. The loss of brow height from postoperative months 3-12 was greater in the GBL group (p<0.05). The postoperative scores on the BPGS were found to be better in both techniques than the preoperative scores (p<0.05). The GAIS score at postoperative month 12 was found to be better in the EAML group. The two groups had similar rates of complications. The two techniques were found to have similar effectiveness and safety profiles for brow rejuvenation.

Normal palpebral anthropometric measurements in Uygur population： A cross-sectional study.

To provide a normative palpebral database for the Uygur subjects to determine norms that may contribute to the diagnosis and prognosis of eyelid diseases. The cross-sectional study was conducted from March to May 2021 at the First People's Hospital of Kashi, China, and comprised Uygur subjects of either gender aged 18-70 years. The slant, height and width of the palpebral fissure, vertical brow-upper lid distance, intercanthal distance, pupillary distance, brow height, crease height and levator function were measured. Data was analysed using SPSS 22. Of the 335 subjects having mean age 41.41±14.53 years, 165(49.3%) were males with mean age 41.08±14.23 years and 170(50.7%) were females with mean age 41.74±14.85 years. There were 107(31.9%) subjects aged 18-30 years, 115(34.3%) aged 31-50 years and 113(33.7%) aged 51-70 years. Mean palpebral fissure width and margin reflex distance of the palpebrae were significantly different in terms of gender (p<0.05). Age was also a significant factor on several counts (p<0.05). Anthropometric measurements of eyelid in Uygur subjects indicated certain peculiarities.

Brow Position Change and its Potential Risk Factors Following Upper Blepharoplasty: A Systematic Review and Meta-Analysis.

Eyebrow position affects human facial expression and aesthetic appearance. However, upper-eyelid surgeries may cause brow position changes and affect the function and aesthetics of the eyebrow. The purpose of this review was to assess the influence of upper-eyelid surgeries on brow position and morphology. PubMed, Web of Science, Cochrane Library, and EMBASE were searched for clinical trials and observational studies published between 1992 and 2022. The brow height from the center of the pupil is analyzed to show the brow height change. The change in brow morphology is measured by the change in brow height from the lateral palpebral and the medial palpebral. Studies are further divided into subgroups according to different surgical techniques, author locations, and whether to conduct skin excision. Seventeen studies met the inclusion criteria. Nine studies and 13 groups were included in the meta-analysis, indicating that brow height decreased significantly after upper-eyelid surgeries (MD = 1.45, 95% CI [0.87, 2.07], P < 0.0001), and simple blepharoplasty, double-eyelid surgery, and ptosis correction can cause the brow position to drop by 0.67, 2.52, and 2.10 mm, respectively. East Asian authors group had a significant decrease in brow height compared with the non-East Asian authors group (28 groups, p = 0.001). Skin excision during blepharoplasty does not affect brow height. Brow position changes significantly following upper blepharoplasty according to the decrease in brow-pupil distance. The morphology of the brow showed no significant postoperative change. Different techniques and authors locations may result in different levels of postoperative brow descent. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective Comparison of Eyebrow Position after Internal and External Browpexy.

Several brow-lift techniques have been used to prevent brow ptosis after blepharoplasty. For example, both internal and external browpexies have been adopted worldwide. However, few studies have compared these two methods. The authors compared postoperative eyebrow position changes between upper eyelid skin excision, internal browpexy, and external browpexy. The authors retrospectively reviewed the cases of 87 patients who underwent upper blepharoplasty performed by a single clinician at their institute between April of 2018 and June of 2020. Patients with routine outpatient photographs taken before and after surgery were enrolled in the study. ImageJ was used to measure brow height at eight points in each eye. Brow height changes were compared among the three groups. Routine photographs were available for 68 patients (133 eyes). Thirty-nine patients underwent internal browpexy (78 eyes), nine underwent external browpexy (17 eyes), and 20 underwent upper eyelid skin excisions (38 eyes). Three months after surgery, significant elevation was noted on the lateral side of the brow in the internal browpexy group and across the whole brow in the external browpexy group. In the upper eyelid skin excision group, whole brow ptosis was observed. Brow-lift outcomes were better in the external than in the internal browpexy group, whereas both browpexy groups showed better outcomes than the upper eyelid skin excision group. Within 3 months of surgery, both internal and external browpexy provided significant brow-lift effects, preventing brow ptosis caused by blepharoplasty with skin excision. External browpexy had better brow-lift outcomes than did internal browpexy. Therapeutic, III.

Modified blink dynamic index predicts activity and severity in patient with facial nerve palsy.

We analyzed the dynamics of blink and defined the blink index in facial nerve palsy (FNP) patients using an ocular surface interferometer associated with clinical characteristics and clinical progress. In total, 49 patients were enrolled this study. All patients were tested using an ocular surface interferometer which is used to measure blink patterns (total blink (TB), partial blink rate (PBR)) and blink dynamics (blink time (BT), lid closing time (LCT), closure time (CT), lid opening time (LOT), interblink time (IBT), closing speed (CS), and opening speed (OS)) using 600 frames recorded over 20 s. The distance of lagophthalmos and modified interpalpebral fissure (IPF), which was defined as the actual moving distance of the upper eyelid, subtracting the distance of lagophthalmos from IPF, was measured using the ImageJ program. The types of FNP were "idiopathic" (Bell's palsy) and "surgical" (following the neurosurgery). Patients were classified into "acute" and "chronic" based on the duration of 6 months from the onset time of FNP. The clinical characteristics were classified into mild or severe according to the severe degree of exposure keratopathy-as "severe" if treatment such as tarsorrhaphy and gold plate insertion was required. Reduced MRD1, brow height, and modified IPF and increased lagophthalmos were noted in the palsy side. LCT was longer and CS, modified CS, and modified OS were shorter in the palsy side. The LCT was longer and the modified CS was shorter in idiopathic patients with acute onset and with clinically severe. IBT was increased in idiopathic patients with clinically severe. Analyzing the blink patterns and blink dynamics, this study suggests meaningful indicators among blink profiles and dynamics, LCT, and modified CS based on modified IPF. It was more associated in the idiopathic type than in the surgical type of FNP patients. The modified CS can be a useful tool for evaluating the activity and severity indicator of FNP.

Aesthetic Analysis of Alteration of Eyebrow and Forehead Position After Endoscopic Eyebrow lift.

Some of the surgeons performing endoscopic brow lift believe that this technique does not lead to clinically significant enlargement of the forehead. The goal of this study is to determine the change in eyebrow and forehead height after endoscopic brow lift and to assess the durability of the result over time. The pre- and postoperative photographs of 97 patients who underwent endoscopic brow lift from January 2016 to July 2020 were standardized and analyzed. The distance between median hairline and upper edge of eyebrow, the distance between upper edge of the eyebrow and edge of the lower eyelid and the distance between edge of the lower eyelid and the nasal base were measured, and the change in the upper face proportion was measured and analyzed. There was statistically significant brow elevation after endoscopic brow lift in all three time periods (less than 1 month, 1-6 months and greater than 6 months). Forehead height did not change to a significant degree, while eyebrow height was increased statistically significant. A longitudinal study on 14 patients for whom multiple follow-up data were available showed that the increase in periorbital height appears to be sustained over time, whereas the change in the forehead height is not as readily apparent, resulting in a bigger relative change in the periorbital compared to the forehead height. The brow height increased more than the forehead height, corroborating the fact that most of our patients have not complained about forehead becoming larger. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Impact of Brow-Lift on Eyelid Closure in Patients with Facial Paralysis.

Background: Brow-lift-induced eyelid closure impairment is commonly discussed in patients with facial paralysis but has not been well quantified. Objective: To measure the limitation of eyelid closure in patients with facial paralysis using simulated brow-lift with tape. Design, Setting, and Participants: For 50 facial paralysis patients with brow ptosis who visited our institution from October 2017 to December 2020, brow-lift was simulated by elevating the paralyzed-side brow using surgical tape, and closed palpebral fissure heights in spontaneous blinking were measured using high-speed videography. The effect of several factors on the change in closed palpebral fissure height was evaluated by multiple linear regression analysis. Results: Greater patient age (p = 0.021), single eyelids (p = 0.003), higher value of closed palpebral fissure height before simulation (p = 0.004), and higher value of brow elevation (p = 0.013) were significant for the increase of closed palpebral fissure height. Conclusions: Brow elevation to the degree that achieves symmetrical brow height could be detrimental to eyelid closure in patients with facial paralysis, especially who are elderly, have single eyelids, or present with preoperative decreased lid-closure function. UMIN Clinical Trials (UMIN Registry No. 000042974).

Changes to Eye Whiteness and Eyelid/Brow Position With Topical Oxymetazoline in Aesthetic Patients.

Oxymetazoline hydrochloride 0.1% ophthalmic solution has recently been approved in the United States for the treatment of ptosis. The aim of this study was to assess the upper and lower eyelid position as well as the brow position and the color of the sclera following the ophthalmic administration of oxymetazoline hydrochloride 0.1%. In this prospective cohort study, consecutive patients presenting with ptosis received topical oxymetazoline 0.1%. The primary outcome was measurement of the upper eyelid height (margin-to-reflex distance 1 [MRD1]) and lower eyelid height (MRD2) relative to the center of pupil, along with assessment of brow height, measured on photographs at baseline and 2 hours after instillation of oxymetazoline. The secondary outcome was the assessment of the color of the sclera (eye whiteness) before and after treatment with a novel color space algorithm. Twenty-nine patients participated in the study. The mean [SD] MRD1 at baseline was 2.3 [0.6] mm. At 2 hours following oxymetazoline treatment, the mean MRD1 significantly increased to 4.2 [0.9] mm (P < 0.01). The mean MRD2 also significantly increased from 5.3 [0.9] mm to 5.7 [1.0] mm (P < 0.01). Brow position did not change with treatment (P = 0.4). Following treatment, the eye sclera became significantly whiter, with a mean ΔEab (color change) of 9.7 [3.9], with 57 out of 58 eyes experiencing a significant change in color. A change of ΔEab ≥2 is considered visually perceptible to the human eye. Within 2 hours of use, oxymetazoline significantly improves the size of the palpebral aperture (MRD1 + MRD2) and also makes the eye appear significantly whiter.

25878 Brow shape and height after treatment with abobotulinumtoxinA in the glabellar lines

Introduction: As one of the first places the eye focuses, the brow is important to the overall aesthetic of the face and of vital importance to facial expressions. Patients are commonly treated with abobotulinumtoxinA (ABO) in the glabella, but few objective measures are available regarding the effect on the overall brow height or shape.

Eyebrows, Facial Expression, and “Poem to the Eyebrow (Blason du Sourcil)”

This review aims to introduce the role of facial expression in communication, the areas involved in facial expression especially the eye and eyebrow, the "Poem of the Eyebrow" (Blason du Sourcil), and preferred brow archetypes.The ability to interpret and respond properly to facial expressions contributes to emotional self-competence and satisfactory social and cognitive development. Certain areas may intensify the emotional message, clarifying the expression and reducing ambiguity. Specific facial areas might make expressions more difficult to interpret. The region of the eye is the most prominent facial region for emotion interpretation. Roles of eyebrow density and position in the interpretation of facial expression of emotion depend, at least in part, upon the emotion being expressed. For face recognition, the eyebrows may be at least as influential as the eyes.French poet Maurice Sceve wrote "Poem to the Eyebrow." This poem contains some noteworthy verses about the function of the eyebrow: Eyebrow that makes the boldest fearful, and gives courage to even cowards.Among brow archetypes, "Anastasia type" (brow starts on a perpendicular line drawn from the middle of the nostril, arches on a line drawn from the center of the nose through the center of the pupil, and ends on a line drawn from the edge of the corresponding nasal ala through the outer edge of the eye) was the most preferred. The middle brow height was most preferred (the distance from the lateral canthus to the lateral end of eyebrow is two-thirds of the eye width).

PeriorbitAI: Artificial Intelligence Automation of Eyelid and Periorbital Measurements

To develop a deep learning semantic segmentation network to automate the assessment of 8 periorbital measurements DESIGN: Development and validation of an artificial intelligence (AI) segmentation algorithm METHODS: A total of 418 photographs of periorbital areas were used to train a deep learning semantic segmentation model to segment iris, aperture, and brow areas. These data were used to develop a post-processing algorithm that measured margin reflex distance (MRD) 1 and 2, medial canthal height (MCH), lateral canthal height (LCH), medial brow height (MBH), lateral brow height (LBH), medial intercanthal distance (MID), and lateral intercanthal distance (LID). The algorithm validity was evaluated on a prospective hold-out test set against 3 graders. The main outcome measures were dice coefficient, mean absolute difference, intraclass correlation coefficient, and Bland-Altman analysis. A smartphone video was also segmented and evaluated as proof of concept. The AI algorithm performed in close agreement with all human graders, with a mean absolute difference of 0.5 mm for MRD1, MRD2, LCH, and MCH. The mean absolute difference between graders is approximately 1.5-2 mm for LBH and MBH and approximately 2-4 mm for MID and LID. The 95% confidence intervals for all graders overlapped in most cases, demonstrating that the algorithm performs similarly to human graders. The segmentation of a smartphone video demonstrated that MRD1 can be dynamically measured. We present, to our knowledge, the first open-sourced, artificial intelligence system capable of automating static and dynamic periorbital measurements. A fully automated tool stands to transform the delivery of clinical care and quantification of surgical outcomes.