Upper blepharoplasty addresses aging-related changes by removing excess skin, muscle, and fat from the upper eyelids. This systematic review, which was registered a priori, improves upon previously published reviews regarding functional and aesthetic outcomes following upper blepharoplasty. Custom search strategies were applied across multiple databases, namely MEDLINE (United States National Library of Medicine, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Google Scholar (Alphabet, Inc., Mountain View, CA), Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, London, UK), Science Citation Index (Clarivate Analytics, Philadelphia, PA), PubMed (United States National Library of Medicine), and PsychInfo (American Psychological Association, Washington, DC). Bias was assessed with the Cochrane RoB 2 tool, and methodological quality was evaluated with GRADE. Out of 6799 articles, 12 randomized controlled trials with 450 patients (39 men, 411 women) were included. The meta-analysis showed significant reduction in dry eye symptoms post-upper blepharoplasty compared with preoperative status (odds ratio [OR], 0.22; 95% CI, 0.13-0.36; P < .00001). No significant difference in postoperative dry eye incidence was found between orbicularis oculi muscle plus skin excision and skin-only excision (OR, 1.55; 95% CI, 0.86-2.80; P = .25). However, muscle plus skin excision had a higher incidence of lagophthalmos (OR, 7.98; 95% CI, 1.41-45.21; P = .02). No significant differences were observed in eye irritation (OR, 1.21; 95% CI, 0.51-2.84; P = .66) or patient satisfaction (OR, 1.14; 95% CI, 0.42-3.14; P = .80). Continuous suturing techniques increased eye irritation compared with subcuticular suturing (OR, 1.77; 95% CI, 1.07-2.91; P = .03). All studies were high quality with a low risk of bias. The findings support upper blepharoplasty's efficacy in reducing dry eye symptoms, with muscle-sparing techniques minimizing lagophthalmos and maintaining high patient satisfaction.

This study aims to compare the lateral brow-eyelid contour following traditional blepharoplasty versus blepharoplasty with brassiere sutures using 3D imaging.

This prospective, randomized, comparative, parallel-group trial involved 56 female patients with dermatochalasis. Patients with an odd number of letters in their first names underwent traditional upper blepharoplasty (group A), while the rest underwent blepharoplasty with orbicularis oculi muscle fixation (group B). All procedures were performed by a single surgeon. Postoperative 3D photographs were standardized in a three-quarter view and analyzed using textured overlays.

In traditional blepharoplasty, 64.5% of patients exhibited flatter eyelid contours with shorter lower convexity. In contrast, the brassiere suture group showed increased convexity above and below the eyelid crease and increased tarsal platform show in 60% of patients.

The authors recommend preserving and repositioning fat in upper blepharoplasty for its safety and aesthetic benefits.

This study investigates the effects of levator advancement, with and without upper blepharoplasty, on dry-eye symptoms in patients with unilateral ptosis. A total of 92 patients were included, divided into three groups based on surgical intervention: Group A (ptosis correction alone), Group B (ptosis correction with blepharoplasty), and Group C (blepharoplasty alone). Dry-eye parameters were assessed preoperatively and postoperatively at 1, 3, and 6 months using Tear Break-Up Time (TBUT), Schirmer test, corneal and conjunctival staining, and the Ocular Surface Disease Index (OSDI) questionnaire. Our findings indicate that patients in Groups A and B exhibited a temporary increase in dry-eye symptoms, with the most significant effects observed in Group B at the 1- and 3-month follow-ups. By 6 months, dry-eye parameters in all groups returned close to baseline levels, underscoring the reversible nature of these symptoms. This study highlights the importance of preoperative counseling regarding potential temporary dry-eye symptoms, particularly for patients undergoing combined ptosis and blepharoplasty procedures. The results support the safety of these surgical approaches, provided there is appropriate patient monitoring and management to ensure symptom resolution over time.

Upper blepharoplasty is a common aesthetic procedure aimed to address dermatochalasis of the eyelid and improve visual acuity. During the postoperative period, patients may experience complications that are usually minor and transient. However, these complications may adversely affect the healing process, delaying the desired result. Accordingly, we present a case of a 57-year-old female with late and transient unilateral blepharoptosis after cosmetic upper blepharoplasty. Preoperative examination revealed the presence of bilateral upper eyelid dermatochalasis and mild prolapse of the nasal fat pad, normal function of the orbicularis oculi, levator palpebrae superioris and frontalis muscles, without evidence of ptosis. Medical history included hyperlipidemia without other significant comorbidities. We hypothesize that the additional local anesthetic injection at the affected eyelid in combination with the persistent edema could have caused the development of ptosis. Therefore, we emphasize the careful use of local anesthetic solution in cases of blepharoplasty and the detailed preoperative examination of the patients to exclude the presence of preexisting blepharoptosis. Moreover, we propose an intraoperative strategy to reduce the possibility of injury of the levator palpebrae superioris muscle and aponeurosis, and therefore to improve postoperative recovery in upper blepharoplasty.

Topical application of ophthalmic drugs remains to be the preferred delivery method. Eye drops lead the pharmaceutical forms due to ease of application. Despite the poor bioavailability of drugs administered topically, especially related to the dilution and excretion by tear fluid, the absence of controlled drug delivery, and the poor compliance within pediatric and senior populations, eye drops and ointments are still the first choices in eye-related disorders management. Only a few studies have explored the eyelid skin as a site for drug application and transdermal delivery as an alternative route of administration of ophthalmic drugs. Such works have validated the delivery of drugs into the ocular tissues through the eyelid barrier. The eyelid represents a differentiated skin barrier concerning the thickness, the structure of the stratum corneum, the vasculature, and the amount of lipids. This work intends to question why the eyelid, being an accessible, non-invasive, comfortable route of administration is not considered a feasible route for ophthalmic drugs. The eyelid structure is presented, and the anatomical and physiological distinctive characteristics are presented. The work also presents the research work on topical drug application to the eyelid skin that has been published so far.

To evaluate the effect of upper eyelid blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on corneal topographic parameters, anterior segment parameters, intraocular pressure, and ocular biometry.

This prospective study examined 428 eyes of 214 patients with dermatochalasis. Patients were divided into two groups randomly: those who underwent orbicularis oculi muscle excision (Group 1) during blepharoplasty and those who did not (Group 2). Following a detailed ophthalmological examination, corneal topography was used to evaluate the eyes anterior chamber depth (ACD), iridocorneal angle (ICA), keratometry measurements, and corneal astigmatism (CA) in the preoperative and postoperative first and third months. Ocular biometry was used to assess axial length (AXL) and intraocular lens (IOL) power. Goldmann applanation tonometry was used to measure intraocular pressure (IOP).

The age and gender distribution between the groups were similar (p = 0.595 and p = 0.493, respectively). In Group 1, the mean steep keratometry (K2) value increased by 1.1 D and the mean CA increased by 0.81 D in the first month (p < 0.001 for both comparisons). The increases in K2 and CA were 0.7 D and 0.63 D, respectively, in Group 2 (p < 0.001 and p = 0.004, respectively). At the postoperative third month, both groups demonstrated statistically significant persistent elevations in K2 and CA values (p < 0.05 for all comparisons) compared to preoperative measurements. Group 1 exhibited statistically significant decreases in both IOL power calculations (0.43 D according to the Barrett formula and 0.40 D according to the SRK/T formula, p < 0.001, for both) and ICA (38.1 ± 4.7° vs. 35.8 ± 4.1°, p = 0.009) measurements at the only one-month postoperative follow-up. IOP, AXL, and ACD measurements did not exhibit any significant changes in both groups at the first and third postoperative months.

In addition to changes in keratometry and CA, blepharoplasty with muscle excision significantly decreased IOL power and ICA. It may be beneficial to inquire about recent blepharoplasty history and the surgical technique employed in patients scheduled for cataract or refractive surgery.

Background The periorbital area undergoes transformative changes with age, influencing both aesthetic appearance and functional aspects of the eyelids. Age-related alterations involve volume loss, shifts in eyelid crease position, drooping eyebrows, reduced skin elasticity, and the presence of dermatochalasis. Dermatochalasis, characterized by redundant upper eyelid skin folds, poses aesthetic and functional challenges, impacting visual acuity and eyelid elevation efficiency. Upper blepharoplasty addresses these age-related changes. Despite the elective nature of upper blepharoplasty, the procedure can evoke preoperative anxiety and discomfort. Various premedication strategies, including benzodiazepines, aim to alleviate anxiety and enhance the overall patient experience. However, ongoing debates persist regarding the optimal strategy for implementation. The study aims to contribute insights into the effectiveness of different premedication approaches in optimizing patient comfort during and after upper blepharoplasty. Methods The research design involves 182 patients divided into three groups: control group (CG) (n = 45) receiving no premedication, Group 1 (n = 98) receiving oral midazolam (a benzodiazepine), and Group 2 (n = 39) receiving a combination of midazolam, eutectic mixture of local anesthetics (EMLA) eyelid ointment, and oral paracetamol with codeine phosphate hemihydrate. The study assesses anxiety levels, pain perception during local anesthetic injection, surgery, and postoperatively, as well as the use of painkillers and adverse effects. Ethical approval was obtained for the study. Results Significant differences were noted among the groups during local anesthetic injection (p < 0.0001), surgery (p < 0.0001), and post surgery (p < 0.0197). CG patients experienced higher pain levels during local anesthetic injection and surgery compared to Groups 1 and 2. Group 1 reported more pain during surgery than Group 2. Substantial differences were observed in preoperative (p < 0.0001), during-surgery (p < 0.0001), and after-surgery (p < 0.0001) anxiety levels. The CG exhibited higher preoperative anxiety compared to Group 1, while Group 1 had lower anxiety during surgery compared to the CG. Group 1 also reported lower anxiety after surgery than both the CG and Group 2. A significant difference was found in post-surgery painkiller usage among the groups (p = 0.0003). Group 2 showed significantly lower usage compared to Group 1 (p = 0.0004) and the CG (p = 0.0006). A significant difference was observed in the duration of painkiller use after surgery (p < 0.0014). The CG had a longer duration than Group 1 (p = 0.0049) and Group 2 (p = 0.0495). Conclusions Midazolam alone as premedication effectively reduced anxiety before, during, and after surgery. EMLA administration for injection pain did not produce superior results, likely due to its delayed onset. Paracetamol with codeine phosphate hemihydrate effectively reduced surgical pain and postoperative pain duration and decreased the need for painkillers.