Functional and Aesthetic Outcomes After Upper Blepharoplasty: A Systematic Review and Meta-analysis of Randomized Control Trials
Dominik Todorov, Sebastian Mitchell, Mustafa Al-Hashimi, Zaid Dajani, Kelvin Sunn Hoah Yap, Hassan Imtiaz, Kian Daneshi, Ankur Khajuria
Abstract
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.