Method
- Single-patient case report.
- Patient: 28-year-old woman with a unilateral multiple eyelid fold after revision double-eyelid surgery.
- Independent levator function confirmed intact before treatment.
- Treatment: 5 units of onabotulinumtoxinA injected above the affected brow, termed "chemical decompensation" by the authors.
- Evaluated with paired photographs, perceived-improvement ratings from 5 evaluators, and eyelid-opening measurements.
- Follow-up ultrasonography performed 116 days after the injection.
Findings
- At 1 week, paired photo review showed reduced multiple folding.
- Mean visual analog scale perceived-improvement score: 7.3 (± 0.67), rated by 5 evaluators.
- No observed functional compromise.
- Follow-up ultrasonography at day 116 showed findings consistent with a local adhesion or fixation point.
- The authors state the response supports, but does not independently confirm, that frontalis muscle pull contributed to the fold, and does not quantify how much of the deformity was muscle versus scar tissue.
What it means for a patient
- In this one patient, a temporary brow-area botulinum toxin injection reduced an unwanted secondary eyelid crease that followed a revision double-eyelid surgery.
- The authors describe the effect as temporary, meant to help during recovery and scar maturation, not as a permanent fix.
- The injection response is framed as supportive, case-specific information, not a validated diagnostic test, and it does not replace a definitive revision surgery when one is needed.
- This is a single case report (level of evidence IV). The authors call for validation in larger patient groups.
Citations
PubMed https://pubmed.ncbi.nlm.nih.gov/42760355/.
Terms
- Double-eyelid surgery: surgery that creates or redefines an upper eyelid crease, commonly requested by patients without a natural fold.
- Revision surgery: a repeat operation to correct the result of an earlier surgery.
- Frontalis muscle: the forehead muscle that raises the eyebrows.
- Levator function: the strength and range of motion of the muscle that lifts the upper eyelid.
- OnabotulinumtoxinA: a brand of botulinum toxin injection that temporarily weakens targeted muscles.
- Visual analog scale (VAS): a rating scale where evaluators mark a point along a line to score severity or improvement.