A Dual Approach to Understanding Facial Perception Before and After Blepharoplasty

Transient Postinflammatory Hyperpigmentation Following Eyelid Surgery

PURPOSE

The authors' aim was to describe a rare mild complication of eyelid surgery presenting as transient hyperpigmentation along the suture lines.

METHODS

A retrospective case series of 6 patients experiencing transient hyperpigmentation following eyelid surgery. Each patient underwent either blepharoplasty alone or blepharoplasty with ptosis repair utilizing Müller muscle conjunctival resection. Data including surgery type, hyperpigmentation laterality and location, time to diagnosis, follow-up time, and outcome were assessed.

RESULTS

All 6 patients with hyperpigmentation were females. All patients underwent blepharoplasty, including 1 upper eyelid blepharoplasty and 4 with both upper and lower eyelid blepharoplasty. One patient underwent bilateral upper blepharoplasty with concurrent posterior approach ptosis surgery repair of the left upper eyelid. Hyperpigmentation was bilateral in all 5 blepharoplasty cases and unilateral in the ptosis repair case. Hyperpigmentation included the medial portion of the operated upper eyelid in all cases. Time to diagnosis ranged from 1 to 4 weeks postoperatively, and follow-up time ranged from 3 to 5 months. Management was conservative in all cases. Five patients experienced complete resolution, and 1 patient experienced near-complete resolution on a 3-month follow-up.

CONCLUSIONS

Transient hyperpigmentation is a rare posteyelid surgery complication, generally with an excellent outcome not requiring additional intervention.

Perceived change in age after functional upper blepharoplasty

PURPOSE

To evaluate the perceived age of patients before and after functional upper blepharoplasty.

METHODS

Retrospective chart review of patients who underwent upper blepharoplasty by a single surgeon at an academic center. The inclusion criterion was having external photographs before and after blepharoplasty. Exclusion criteria included any other concurrent eyelid or facial surgery. Primary endpoint: perceived change in age after surgery as judged by the American Society of Ophthalmic Plastic & Reconstructive Surgery (ASOPRS) surgeons.

RESULTS

Sixty-seven patients (14 men, 53 women) were included. Mean pre-operative age was 66.9 years (range 37.8-89.4) and mean post-operative age was 67.4 years (range 38.6-89). The mean perceived age pre-operatively was 68.9 years, and the mean perceived age post-operatively was 67.1 years, a change of 1.8 years (p = 0.0001 by two-tailed paired T-test). Inter-rater reliability of the observers was measured by intraclass correlation coefficient of 0.77 for pre-operative and 0.75 for post-operative photos. The decreased perceived age was 1.9 years for women, 1.4 years for men, 0.3 years for Asians, 1.2 years for Hispanics, and 2.1 years for whites.

DISCUSSION

Functional upper blepharoplasty by an experienced ASOPRS surgeon was shown to reduce the perceived age of a patient by an average of 1.8 years.

Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty: A Large Cohort Study

Background

Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome.

Objectives

We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty.

Methods

This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants.

Results

A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes.

Conclusions

Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.

A Modified Palpebral Marginal Incision Technique Using Levator Aponeurotic Flap in Blepharoplasty

BACKGROUND

Double-eyelid surgery is one of the most common cosmetic surgeries performed in Asians. The palpebral marginal incision technique (PMIT) conceals the incision scar and creates natural-looking double eyelids. However, the amount of eyelid skin removed by conventional PMIT is limited, which potentially results in an unnatural crease or swollen-like inferior skin below the palpebral crease.

OBJECTIVES

To introduce a modified PMIT which creates scarless, dynamic and natural double eyelids with a limited amount of eyelid skin excision.

METHODS

From January 2018 to December 2020, 382 patients (764 eyelids) underwent double eyelid surgeries using the described technique. The key point was to form a pretarsal levator aponeurotic flap, acting as a soft motor transmission to bridge tarsus, orbicularis oculi muscle (OMM), and skin dermis. The overall aesthetic outcomes, which are indicated by surgeon and patient self-assessed satisfaction, and complications, were postoperatively evaluated at different follow-ups.

RESULTS

The mean follow-up period was 7.6 months (range, 6-12 months). Of the patients, 332 (86.9%) reported a satisfactory self-assessment of outcomes and 37 (9.7%) as fair. Secondary operations were required for 13 (3.4%) patients for double-eyelid asymmetry or crease curve malformations. Early-stage hematoma (12 cases) and lagophthalmos (19 cases) were observed and completely recovered within 1 month.

CONCLUSIONS

Our modified PMIT technique was capable of achieving scarless and natural-looking double eyelids with biomimetic anatomical structure.

Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study

BACKGROUND

To determine the success of an upper blepharoplasty, a popular cosmetic procedure, it is essential to measure outcomes from the patient perspective because these often outweigh objective outcomes.

OBJECTIVES

This study aimed to assess patient-reported satisfaction with facial appearance, psychological well-being, and aging appraisal after upper blepharoplasty with validated questionnaires.

METHODS

This prospective cohort study included upper blepharoplasty patients from 8 outpatient clinics. Patient-reported satisfaction was assessed with the FACE-Q at intake, and 6 and 12 months postoperatively.

RESULTS

In total, 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured 6 months postoperatively. Large improvements in FACE-Q scores (range, 0-100) between intake and 6 months postoperatively were seen for satisfaction with appearance (mean, effect size: eyes +48, 2.6; upper eyelids +48, 3.1; facial appearance overall +26, 1.4), psychological well-being (+11, 0.56), and aging appraisal (+22, 1.0). Patients reported they appeared a mean [standard deviation] 3.3 [5.2] years younger postblepharoplasty. No clinically relevant changes were seen between 6 and 12 months. Additionally, improvements in appearance were not dependent on their intake scores, whereas improvements in psychological well-being and aging appraisal were smaller in patients with higher intake scores. Satisfaction with treatment outcome was strongly correlated with appearance satisfaction but not with aging appraisal.

CONCLUSIONS

Significant improvements in patient satisfaction regarding appearance, psychological well-being, and aging appraisal can be seen 6 months after blepharoplasty, and outcomes remain stable up to 12 months postoperatively. These data may be used to inform patients and clinicians and improve the overall quality of care.

LEVEL OF EVIDENCE: 4

Observer-Reported Outcomes and Cosmetic Procedures: A Systematic Review

BACKGROUND

Cosmetic procedures have demonstrated beneficial effects on physical appearance based on anatomic markers as well as patient-perceived self-image and quality of life. Recent studies of observer-reported outcomes (OROs) suggest an additional benefit from aesthetic interventions.

OBJECTIVE

The authors aimed to review the evidence of OROs from cosmetic procedures performed on the head and neck.

PATIENTS, METHODS AND MATERIALS

PubMed, Embase, and Cochrane Library databases were searched for relevant studies, yielding 24 included original investigations.

RESULTS

These studies captured 686 total patients, 8,257 observer evaluations, and a variety of interventions including face-lifts, blepharoplasty, rhinoplasty, and minimally invasive treatments including botulinum toxins and hyaluronic acid fillers. Forty-one distinct reported OROs were grouped into 12 descriptive domains. Domains were further grouped into 3 higher-order categories: aesthetics and wellness, social capacities, and skills and competencies. Improved perception after cosmetic intervention is most reproducibly demonstrated for the following ORO domains: age, attractiveness, sociability, relationship success, and occupational and financial competency.

CONCLUSION

The synthesized findings imply a tertiary layer of benefit for cosmetic intervention beyond anatomical and patient-centered outcomes through enhanced perceptions of others. These findings may inform the pre-procedure risk-benefit discussion with patients of cosmetic medicine and drive future research into longitudinal outcomes.

Comparison of Palpebral Marginal and Traditional Incision Techniques for Double-Eyelid Surgery

BACKGROUND

The palpebral marginal incision technique is a novel method for double-eyelid surgery. However, studies comparing palpebral marginal and traditional incisions are scarce. We aimed to compare the two techniques with respect to post-operative patient satisfaction and complications.

METHODS

This retrospective analysis included 422 patients who underwent double-eyelid surgery with either the palpebral marginal incision or traditional incision at the Medical Cosmetology Department of Tianjin Eye Hospital from February 2015 to September 2018. Patients were divided into the palpebral marginal (n = 280, 66.4%) and traditional incision (n = 142, 33.6%) groups. Patient satisfaction at 3 and 6 months post-operatively and incidence of complications were compared between the groups. The average post-operative follow-up duration was 6.75 months.

RESULTS

The palpebral marginal incision group was younger than the traditional incision. There were no significant differences in sexes between the groups. Compared with the traditional incision group, the palpebral marginal incision group had greater patient satisfaction at 3 months post-operatively. Patient satisfaction at 6 months post-operatively and total incidence of complications were similar between the groups. Incidence of hypertrophic scar formation was lower in the palpebral marginal incision group. Other complications showed no significant between-group differences.

CONCLUSIONS

The palpebral marginal incision technique has similar surgical outcomes to the traditional incision technique. Our findings confirm that the advantages of the palpebral marginal incision technique include almost indiscernible surgical scarring and faster post-operative recovery, which may result in increasing popularity among young people. Therefore, we suggest that the palpebral marginal incision technique is reliable and worthy of recommendation.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.