Discussion
’ overall cosmetic, infection, milia, blepharoplasty
SCAR, ADVERSE EFFECTS, WOUND DEHISCENCE, INFECTION, EXCESSIVE TEARING
As blepharoplasty is the most commonly performed facial plastic and periorbital procedure [Other studies applied eyelid-specific scar scales. For example, a non-validated In recent years, validated questionnaires have been developed specifically for patients undergoing facial procedures. With the development of the FACE-Q scales, patient-reported outcome measures for surgical and nonsurgical aesthetic facial procedures have become available. These, like widely used BREAST-Q and BODY-Q scales, were developed according to the international guidelines for patient-reported outcome instrument development.[Patient 'Satisfaction with Eyes' assessment focuses on the shape as well as how attractive, alert, open, bright-eyed, nice, and youthful patients’ eyes appear.[The strong increase in satisfaction mirrors surgeons’ overall cosmetic evaluation, showing minimal scar formation 3 months after blepharoplasty. This rating was independent of the suturing technique used. However, age and sex had an influence on the surgeons’ perception, as age had a statistically significant influence at day 7 ratings, whereas sex had a statistically significant influence at 3 months after blepharoplasty. The postoperative increase in patient satisfaction is further in accordance with a previous study. Domela-Nieuwenhuis et al. found an increase in 48 FACE-Q RASCH points in a large multicenter trial including over 2000 patients.[FACE-Q ‘Appraisal of Upper Eyelids’ focuses on how various aspects of the upper eyelids may bother the patient. Consequently, a low initial RASCH score represents patients severely bothered by eyelid skin on lashes, saggy, droopy, or heavy eyelids, folds, tired or old looks due to the upper eyelids. Our results indicate that the lower the initial RASCH score, the stronger the increase in RASCH score 3 months after surgery. On average, the appraisal RASCH score increased by 65 points. This finding is independent of the suturing technique used. A large-scale study including over 2000 patients with a 50% response rate showed an average change of 47 RASCH score points.[Studies show that adverse effects occur rarely after upper eyelid blepharoplasties.[FACE-Q adverse effects reported by patients included scar formation, eye irritation, excessive tearing, hollowing of eyes, and difficulty closing eyes. In addition, two surgeons rated infection, milia, and wound dehiscence 7 days after blepharoplasty. Overall, the before-mentioned adverse effects occurred in 37% (42) of all patients. There was no statistically significant difference between wound closures, either 7 days or 3 months after upper eyelid blepharoplasty regarding adverse effects. See Table A recent study comparing two surgical techniques (skin only and additional orbicularis oculi muscle excision) showed no statistically significant differences in FACE-Q adverse effects. Consequently, the surgical technique may potentially be ruled out as a source of adverse effects.[A limitation of this study is that the patients included mostly presented with visual field restriction before undergoing blepharoplasty. Care is needed when extrapolating these results to patients undergoing upper eyelid blepharoplasty for cosmetic reasons only. Also, the findings only apply to the suturing material used. Consequently, there is still a need to gain insight as to whether our results are true for other suturing materials available. The strength of this study clearly is its assessment with validated patient-reported outcome measures, prospective design, and low dropout rate.In summary, our study found no statistically significant difference between running cutaneous and subcuticular closing techniques regarding patient satisfaction and appraisal of upper eyelids 3 months after blepharoplasty. This study further demonstrated that satisfaction of pre-operatively unhappy/dissatisfied patients was more likely to increase compared with patients who reported themselves rather satisfied before blepharoplasty. Ratings by two graders showed good overall agreement.