Identifying Aesthetically Appealing Upper Eyelid Topographic Proportions

Background: The goal of upper eyelid procedures is to restore or create the ideal proportions between the pretarsal space and the upper lid fold. Objectives: The aim of this study was to define the topographic features of the attractive upper lid. Methods: Caucasian female frontal facial photographs were obtained from public media and periorbital areas were cropped. A total of 294 photographs of eyes were rated by 6 evaluators using a 4-point Likert scale. Eyes rating an average ≥3.5 were defined as "attractive," whereas those rated ≤2.0 were defined as "unattractive" and analyzed using Adobe Illustrator. Results: Fifty-one and 19 eyes were included in the attractive and unattractive cohorts, respectively. (Upper lid foldPretarsal) shows ratios averaged between 1.8 and 3.0 among attractive eyes, and larger ratios were observed laterally. These ratios were significantly larger laterally among attractive vs unattractive eyes (P ≤ 0.003). The lash line peak (P < 10^-4), lid crease peak (P < 10^-3), and brow peak (P < 0.05) were significantly more lateralized in attractive eyes. Conclusions: Attractive eyes tend to exhibit decreased pretarsal show. However, there is pronounced variability in these ratios among attractive eyes, suggesting the importance of other features. Interestingly, progressive lateralization of the lash line, lid crease, and brow peaks appears to be an undescribed feature common to attractive eyes. Knowledge of attractive eyelid features may be an important consideration for planning and optimization of upper lid rejuvenation procedures.