Upper blepharoplasty:Defying dogmas and clarifying uncertainties

Upper blepharoplasty is one of the most commonly performed procedures by (oculo)plastic surgeons and it is generally recognized as a relatively easy technical procedure. However, seemingly minor aspects before, during and after surgery can be identified that significantly contribute to surgical outcome and patient satisfaction. Expansion of the knowledge of these aspects, followed by incorporation in clinical practice of novel findings, may allow plastic surgeons to further enhance the upper blepharoplasty outcome with concomitant low patient discomfort and high patient satisfaction. With our investigations we have attempted to clarify some of the prevailing uncertainties and ambiguities in upper blepharoplasty care. First of all, we have addressed two technical aspects of the procedure: the use of an alternative anesthetic agent to reduce pain during injection and a suture technique to reduce suture abscess formation. We have demonstrated that lidocaine with epinephrine is less painful; causes less postoperative edema, erythema and hematoma; and provides better hemostasis during upper blepharoplasty than prilocaine with felypressin. Furthermore, starting the suture within the wound reduces wound inflammation and suture abscess formation. Two (potential) consequences of upper blepharoplasty are addressed next, namely the sensory disturbances and the asymmetry that can occur or aggravate. We have demonstrated that sensibility fully recovers and that asymmetry is reduced after the blepharoplasty procedure. Last but not least, we have focused on to two widely applied rituals in upper blepharoplasty care and have confirmed that postoperative cooling and the use of arnica do not avert or reduce postoperative swelling, bruising and/or pain