Analysis of lid contour change with aging in asians by measuring midpupil lid distance

Background: The purpose of this study was to analyze the upper eyelid contour of normal adults and differences of these contour according to sex and age in Asians using a software program that measures multiple radial midpupil lid distance. Methods: Conventional and 12 oblique midpupil lid distances every 15 degrees across the temporal (105, 120, 135, 150, 165, and 180 degrees) and nasal (75, 60, 45, 30, 15, and 0 degrees) fields of the lid fissure of 360 healthy Korean subjects older than 20 years and younger than 80 years in both sexes (30 subjects in each group) were measured using custom software. Midpupil lid distances and angles of the medial and lateral canthal ends were also analyzed, and the palpebral fissure inclination was measured. Results: Midpupil lid distances decreased in all angles with advancing age. When midpupil lid distances at the same angles were compared, the mean differences between those in their 20s, 60s, and 70s at 0° and 180° were statistically significant in males (p = 0.039 and 0.045, respectively). In women, the mean differences in all directions between participants in their 20s and those in their 60s and 70s were statistically significant (p < 0.05). Conclusions: Normal eyelid contour in Asians was the shape of an arch that has higher temporal lid contour than the nasal one. There were remarkable decreases in midpupil lid distances in the temporal sectors of the lid fissure with aging, especially at the lateral canthal end. Consideration of the normal shapes and parameters of eyelid contour may improve preoperative planning in aesthetic and reconstruction procedures of the eyelid to restore youthful eyelids.