Anthropometric Analysis on the Ocular Region Morphology of Children and Young Adults in Chinese Han Population

Automatic Measurement and Comparison of Normal Eyelid Contour by Age and Gender Using Image-Based Deep Learning

Purpose

This study aimed to propose a fully automatic eyelid measurement system and compare the contours of both the upper and lower eyelids of normal individuals according to age and gender.

Design

Prospective study.

Participants

Five hundred and forty healthy Chinese aged 0 to 79 years in a tertiary hospital were included.

Methods

Facial images in the primary gazing position were used to train and test the proposed automatic system for eye recognition and eye segmentation. According to the 10-millimeter diameter circular marker, measurements were transformed from pixel sizes into factual distances.

Main Outcome Measures

Midpupil lid distances (MPLDs) every 15° of all participants were automatically measured in both genders (30 males and 30 females in each age group) by the proposed deep learning (DL)-based system. Intraclass correlation coefficients (ICCs) were performed to assess the agreement between the automatic and manual margin reflex distances (MRDs). The eyelid contour, eyelid asymmetry, and palpebral fissure obliquity were analyzed using MPLD, temporal-versus-nasal MPLD ratio, and the angle between the inner and outer canthi, respectively.

Results

The measurement of MRDs by the automatic system excellently agreed with that of the expert, with ICCs ranging from 0.863 to 0.886. As the age of the participants increased, the values of MPLDs reached a peak in those in their 20s or 30s and then gradually decreased at all angles. The temporal sector showed greater changes in MPLDs than the nasal sector, and the changes were more significant in females than in males. The maximum value of palpebral fissure obliquity appeared before 10 years in both genders and remained relatively stable after the 20s (P > 0.05).

Conclusions

The proposed DL-based eyelid analysis system allowed automatic, accurate, and comprehensive measurement of the eyelid contour. The refinement of eyelid shape quantification could be beneficial for future objective assessment preocular and postocular plastic surgery.

Financial Disclosures

The authors have no proprietary or commercial interest in any materials discussed in this article.

Gender- and Age-Related Characterization of Lower Eyelid Morphology: Three-Dimensional Analysis in a Chinese Population

BACKGROUND

The lower eyelid region is a critical component of the face. It is essential to establish anthropometric reference values for the evaluation of aging, surgical planning and assessment of outcomes in periocular esthetic and rejuvenation procedures. This study aims to provide comprehensive anthropometric data on the Chinese lower eyelid region, into account factors such as sex and age, through three-dimensional imaging analysis.

METHOD

Three-dimensional facial images were obtained from 84 healthy Chinese individuals aged between 20-35 and 50-65 years, as well as eight patients aged between 20 and 35 who presented with eyelid bags. A total of 27 landmarks were identified, leading to the generation of corresponding 21 lines, 5 curves, 4 angles, 2 areas and 5 ratios. The measurements were compared among different age groups, genders and young patients with or without eyelid bags.

RESULTS

Compared to females, males exhibited a more elongated palpebral fissure, lower tear trough and lid-cheek junction, smaller inner and outer canthus angles, as well as a larger area and proportion of the lower palpebral region. As age progressed, the height and width of the palpebral fissure and inner canthus angle decreased gradually, which was accompanied by sagging of the tear trough and lid-cheek junction, an increase in lower eyelid area and swelling of the lower eyelid. Young patients undergoing eyelid bags demonstrated larger and more swelling lower eyelid which held clinical significance for rejuvenation surgery.

CONCLUSION

Males exhibited a higher proportion of the brow-eye unit occupied by the lower eyelid region compared to females. Elderly individuals displayed noticeable drooping of the tear trough and lid-cheek junction, accompanied by swelling in the lower palpebral region. These findings can serve as standard references for esthetic procedures and reconstructive periocular operations.

LEVEL OF EVIDENCE IV

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Establishment and application of perceived age prediction model for the periocular aging research of Chinese Han women

BACKGROUND

The assessment of skin aging through skin measurements faces limitations, making perceived age evaluation a more valuable and direct tool for assessing skin aging. Given that the aging process markedly affects the appearance of the eye contour, characterizing the eye region could be beneficial for perceived age assessment. This study aimed to analyze age-correlated changes in the eye contour within the Chinese Han female population and to develop, validate, and apply a multiple linear regression model for predicting perceived age.

MATERIALS AND METHODS

A naïve panel of 107 Chinese women assessed the perceived ages of 212 Chinese Han women. Instrumental analysis evaluated periorbital parameters, including palpebral fissure width (PFW), palpebral fissure height (PFH), acclivity of palpebral fissure (AX), angle of inner canthal (AEN), and angle of outer canthal (AEX). These parameters were used to construct a multiple linear regression model for predicting the perceived ages of Chinese Han women. A combined treatment using Fotona 4D and an anti-aging eye cream, formulated with plant extracts, peptides, and antioxidants, was conducted to verify the cream's anti-aging efficacy and safety. This eye cream was then tested in a large-scale clinical trial involving 101 participants. The prediction model was employed in this trial to assess the perceived ages of the women after an 8-week application of the eye cream.

RESULTS

All parameters were observed to decrease with age. An intergroup comparison indicated that eyelid aging in Chinese Han women accelerates beyond the age of 50. Consequently, a linear regression model was constructed and validated, with the perceived age being calculated as 183.159 - 1.078 * AEN - 4.487 * PFW + 6.061 * PFH - 1.003 * AX - 0.328 * AEX. The anti-aging efficacy and safety of the eye cream were confirmed through combined treatment with Fotona 4D, showing improvements in wrinkles, elasticity, and dark circles under the eyes. In a large-scale clinical evaluation using this eye cream, a perceived age prediction model was applied, suggesting that 8 weeks of use made participants appear 2.25 years younger.

CONCLUSION

Our study developed and validated a multiple linear regression model to predict the perceived age of Chinese Han women. This model was successfully utilized in a large-scale clinical evaluation of anti-aging eye cream, revealing that 8 weeks of usage made participants appear 2.25 years younger. This method effectively bridges the gap between clinical research and consumer perceptions, explores the complex factors influencing perceived age, and aims to improve anti-aging formulations.

The Aesthetic Evaluation of the Brow-Eye Continuum After Correction of Severe Congenital Ptosis in Children With Extended Frontalis Muscle Advancement Technique

BACKGROUND

Severe congenital ptosis is a common ocular deformity in pediatric patients that can significantly impact visual development and aesthetic appearance, leading to negative psychosocial outcomes. The frontalis muscle advancement technique is a well-established surgical treatment for severe congenital ptosis. Aesthetic changes of the brow-eye continuum often plays an important role in ptosis surgery.

METHODS

We conducted a single-center retrospective case series study of patients with severe congenital ptosis who underwent the frontalis muscle advancement technique at the Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University between April 2020 and June 2021. The study aimed to evaluate the aesthetic changes of the eyebrow-eyelid continuum after surgery. The main outcome measurements included marginal reflex distance 1, palpebral fissure height, eyebrow position, upper eyelid to lower eyebrow distance, lower eyelid to upper eyebrow distance, and nasal base to lower eyelid distance.

RESULTS

The study included 48 patients (66 eyelids), with 30 unilateral and 18 bilateral patients. Our analysis found that eyebrow height decreased by an average of 4.8% postoperatively relative to preoperatively in all patients.

CONCLUSIONS

The frontalis muscle advancement technique has demonstrated effectiveness in achieving aesthetically pleasing outcomes in children with severe ptosis. It is crucial to pay careful attention to the brow-eye continuum during the correction process, as its harmony can greatly impact the final result.

To Achieve a Bullseye: Factors Related to Corneal Refractive Therapy Orthokeratology Lens Toricity

This retrospective study investigated the toricity of dual-axis corneal refractive therapy (CRT) orthokeratology lenses and corneal parameters, including flat keratometry (FK), flat eccentricity (e), steep e, corneal astigmatism, and the difference in elevation at 8 mm chord length. We analyzed the right eyes of 143 adolescent patients who underwent ocular examinations, subjective refraction, and corneal topography before CRT lens fitting by trial lens evaluation. After orthokeratology treatment, all patients underwent a topography map with an intact plus power ring and decentration of <1 mm. The mean patient age was 10.7 ± 2.2 years old; 33% were male. The lens toricity range was 25−100 µm. Multiple linear regression analysis showed significant associations between CRT lens toricity and corneal astigmatism (β = 10.913, t = 3.012, p = 0.003) and the difference in elevation at 8 mm chord length (β = 0.681, t = 4.049, p < 0.001); no association was found between CRT lens toricity and FK, flat e, or steep e (all p > 0.05). Corneal astigmatism was positively associated with difference in elevation at 8 mm chord length (r = 0.743, p < 0.001, Pearson’s correlation), and corneal astigmatism and the difference in elevation at 8 mm chord length were positively associated with CRT lens toricity (r = 0.657 and r = 0.643, respectively; both p < 0.01, Spearman’s correlation). These results suggest that difference in elevation at 8 mm chord length can be used to conveniently estimate CRT lens toricity in clinical practice, using the equation Y (CRT lens toricity) = 1.02X (difference in elevation at 8 mm chord length) + 20.3.

Anthropometric Periocular Soft Tissue Analysis From Preadolescence to Young Adulthood: Photogrammetric Measurements

ABSTRACT

The periocular region has a central role in the prediction of ethnicity, understanding emotional expression, age, and sex. The aim of this study was to determine the sex-related growth changes in the periocular region of Turkish preadolescents, adolescents, and young adults. The study included a total of 234 individuals (preadolescents: 34 females and 40 males; adolescents: 40 females, 40 males, and young adults: 40 males and 40 females). A total of 7 periocular parameters (3 bilateral, 3 unilateral linear, and 1 angular measurement) were analyzed statistically to determine sex-related differences. The palpebral fissure and canthal indexes were also calculated. Of the 14 periocular measurements, 9 were found to be sexually dimorphic in certain age groups (P < 0.05). Right-left palpebral fissure width and left palpebral fissure height were significantly different between young adult males and females (P = 0.018, P = 0.013, and P = 0.027, respectively). A significant sexual dimorphism was observed for outercanthal distance and canthal index in 3 age groups (P < 0.05). The data collected in this study may serve as a sex-dependent database source for the Turkish population during normal growth from preadolescence to young adulthood. The present study results would be useful for planning and designing aesthetic and post-traumatic surgical interventions in the periocular region as well as personal identification in this population.

Vertical enlargement of the palpebral aperture by surgical modification of the lower eyelid: A new cosmetic option for Chinese patients

BACKGROUND

The distinctive features of Oriental eyes are narrow palpebral aperture and upslanting lower eyelid margin, which are not in accordance with modern appreciation of beauty. Although many ophthalmic plastic procedures have been designed to change the characteristic appearance, the methods to enlarge the palpebral aperture by lowering the lower eyelid are limited.

METHODS

A total of 63 Chinese patients received the lowering the lower eyelid procedure from April 2014 to August 2018. The main criteria are patients who have vertically narrow palpebral aperture with or without upslanting lower eyelid shape. But patients who have proptosis or unhealthy lower eyelid elasticity are not suitable for this procedure. The operation is performed by suturing the lower tarsal plate and the infraorbital periosteum together, adjusting the tension of knots to reach the patient's desire for the shape of lower eyelid margin, and finally tightening all the knots.

RESULTS

The lateral lower eyelid margin was lowered and the lateral part of the palpebral aperture was enlarged in all cases (P < 0.01). Only five patients (7.9%) were not fully satisfied because of the partial retraction of the lateral eyelid margin. Minor complications were observed, of which conjunctival chemosis in three patients (4.8%) and conjunctival hemorrhage in two patients (3.2%).

CONCLUSION

Lowering the lower eyelid procedure is an effective and safe approach for patients who desire to smooth the upslanting shape and enlarge the eyes. The strict criteria and careful preoperative evaluations are critical to avoid complications and achieve good outcomes for Chinese patients.

Impact of Canthal Height on Horizontal Upper Eyelid Peak Position: A Guide for Blepharoptosis Surgery

This study was aimed at examining the relationship between the horizontal upper eyelid peak position (Δpeak-pupil) and the difference between the medial and lateral canthal heights (Δcanthi) in Japanese individuals. Images of the left eyelid of 71 participants without eyelid disease were acquired with a camera with a slit-lamp microscope. Multivariate linear regression analysis was performed to determine the influence of age, sex, distance from the pupil center to the upper eyelid margin (margin reflex distance-1), Δcanthi, and palpebral fissure width on Δpeak-pupil. In addition, Δpeak-pupil distribution in participants with Δcanthi <3 (Group A), 3 to 6 (Group B), and >6 mm (Group C) was calculated as the average±2x the standard deviation. The mean Δpeak-pupil was 1.12 ± 1.29 mm (range: -1.44 to 6.12) and the mean Δcanthi was 4.50 ± 1.71 mm (1.02-7.96). Δcanthi was a significant determinant factor of Δpeak-pupil (P < 0.0001), whereas age (P = 0.62), sex (P = 0.88), margin reflex distance-1 (P = 0.29), and the horizontal palpebral fissure width (P = 0.65) were not related to Δpeak-pupil. The normal Δpeak-pupil ranges were -1.47 to 1.52, -0.95 to 3.22, and -0.84 to 4.73 mm in Groups A, B, and C, respectively. There was a statistically significant difference between the Group A and B ranges and between the Group A and C ranges (Kruskal-Wallis test, P < 0.01). It was concluded that the normal eyelid peak position differs according to medial-to-lateral canthal positional difference. This finding may help intraoperative determination of the upper eyelid peak position in blepharoptosis surgery.