Changes of Dry Eye Related Markers and Tear Inflammatory Cytokines After Upper Blepharoplasty

Objectives: To investigate the changes of dry eye-related clinical manifestations, ocular surface parameters, and tear inflammatory cytokines after upper blepharoplasty.Methods: Forty eyes of 20 who underwent upper blepharoplasty were divided into either the group with or the group without preexisting dry eye before upper blepharoplasty. Ocular Surface Disease Index (OSDI), Schirmer I test, tear meniscus height, lipid layer thickness, non-invasive tear break-up time (NIKBUT), fluorescein tear film break-up time (FBUT), corneal fluorescein staining, meibum expression, lid margin changes, and tear inflammatory cytokines were assessed preoperatively and at 1, 3, and 6 months postoperatively. Correlations between inflammatory cytokines and dry eye-related parameters were determined.Results: The OSDI scores increased significantly at 1 month (p = 0.040) and subsequently decreased to the preoperative levels at 6 months postoperatively in subjects with dry eye. First (f)-NIKBUT and FBUT were significantly shortened at 1, 3, and 6 months postoperatively in subjects with dry eye (f-NIKBUT: p <0.001, p = 0.010, p = 0.042; FBUT: p = 0.002, p = 0.005, p = 0.037, respectively), but were only shortened at 1 month (p = 0.028, p = 0.005) and returned to baseline levels at 6 months postoperatively in subjects without preexisting dry eye. A significant increasing trend of interleukin (IL)-6 was found in both dry eye and subjects without preexisting dry eye (p = 0.016, p = 0.008), while IL-8 and tumor necrosis factor alpha (TNF-α) were only found to be increased in subjects with dry eye postoperatively (p = 0.031, p = 0.031). The levels of IL-8 and TNF-α were positively correlated with OSDI scores (p = 0.046, p = 0.043, respectively) and negatively correlated with f-NIKBUT and FBUT (p = 0.026, p = 0.006, respectively).Conclusions: Upper blepharoplasty might increase the release of tear inflammatory cytokines and tear film instability that contribute to the development of postoperative dry eye in the early postoperative period and the changes most relieved in 6 months. Preexisting dry eye is a higher risk factor for worse and persistent ocular surface damage after upper blepharoplasty.

Postoperative Ecchymosis in Upper Blepharoplasty: A Split Face Study of Tranexamic Acid Versus Etamsylate

Objective: To compare the efficacy of tranexamic acid (TXA) versus etamsylate (ETM) in reducing postoperative ecchymosis in upper blepharoplasty. Introduction: With an increase in demand for shortened recoveries after facial aesthetic surgery, various optional approaches have been sought out. In terms of ecchymosis, TXA and ETM have been most commonly used. Method: A prospective, intrapatient split face study was conducted from January 2020 to January 2021 in 40 patients who underwent upper blepharoplasty under local anesthesia. Two equal anesthetic solutions were prepared; Solution A contained TXA and solution B contained ETM. Solution A was injected in the right eyelid and solution B in the left eyelid. Postoperative ecchymosis was assessed by 2 blinded evaluators, the assisting surgeon (Observer 1) and an external surgeon (Observer 2) at 48 h and on the seventh day using a scale published by Sagiv et al. Results: Postoperative ecchymosis was found to be less at 48 h by both observers with TXA solution. Moreover, at the seventh day, no ecchymosis was found in 32.5% with TXA solution compared to 2.5% with ETM solution. Kappa analysis showed concordance between observers. Conclusion: In our study, TXA solution was a more effective therapy when compared to ETM solution for reducing ecchymosis. Larger case studies are required to prove the difference for validation.

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, 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 eight outpatient clinics. Patient-reported satisfaction was assessed using the FACE-Q at intake, six and twelve months postoperative. Results 2134 patients were included. High satisfaction with outcome and decision to undergo treatment were measured six months postoperative. Large improvements in FACE-Q scores (range, 0 - 100) between intake and six months postoperative 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 to appear 3.3 years younger (SD, ±5.2) postblepharoplasty. No clinically relevant changes were seen between six and twelve 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 postoperative. These data may be used to inform patients and clinicians and improve the overall quality of care.

“Split-Face” Evaluation of Collagen Changes Induced By Periorbital Fractional CO2 Laser Resurfacing

Background Periorbital fractional CO2 laser resurfacing has been used for facial rejuvenation purposes. However, to the best of our knowledge, no study objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. Objectives To objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. Methods Prospective and comparative study in which 16 female subjects presenting with dermatochalasis and periorbital rhytids were evaluated. All subjects underwent unilateral periorbital fractional CO2 laser resurfacing 30 days prior to upper blepharoplasty. Quantification of types I and III collagen from laser treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment, 1 and 6-month post-treatment digital images. Results Histochemical analysis showed significant higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; p<0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; p< 0.0001) in the samples submitted to fractional CO2 laser treatment; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed one month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). Conclusions Periorbital fractional CO2 laser resurfacing demonstrated to be an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.