Brow ptosis frequently accompanies dermatochalasis (Fig. 1.78A) and may also follow facial nerve palsy or localized trauma. Lifting of the brow needs to precede or occasionally be combined with upper lid blepharoplasty.

Epicanthic folds are bilateral vertical folds of skin that extend from the upper or lower lids towards the medial canthi. They may give rise to a pseudoexotropia. The folds may involve the upper or lower lids or both; lower lid folds extending upwards to the medial canthal area (epicanthus inversus – Fig. 1.79A) are associated with the blepharophimosis syndrome. Treatment is by V–Y (Fig. 1.79B) or Z-plasty.

Telecanthus is an uncommon condition that may occur in isolation or in association with blepharophimosis and some systemic syndromes. It consists of increased distance between the medial canthi due to abnormally long medial canthal tendons (Fig. 1.80). It should not be confused with hypertelorism in which there is wide bony separation of the orbits. Treatment involves shortening and refixation of the medial canthal tendons to the anterior lacrimal crest, or insertion of a trans-nasal suture.