Modern blepharoplasty: From bench to bedside

Table 1 Studies in current literature regarding blepharoplasty

Ref.	Technique	Type of the study	Where (upper/lower eyelid)	Number of cases	Conclusions
Balzani et al[21], 2013	Laser	Prospective	Upper	20	Lift of 1.63 ± 0.68 mm of the upper eyelid at 6 mo
Bae-Harboe et al[16], 2014		Review	Both	/	Fractional ablative CO2 laser is a valid solution to improve the appearance of periocular area
Toyos[20], 2017		Retrospective	Upper	16	Increase in the measurements for dermatochalasis and skin laxity at 6 mo follow-up and few side effects
Guida et al[23], 2018		Retrospective	Both	20	Increase in the Global Assessment Improvement Scale; reduction of medium protrusions and depressions; improved texture at 2 mo also at 3D image reconstructions
Garcia et al[22], 2019		Cohort, uncontrolled	Lower	263	Improvement in the eyelid area characterized by fewer rhytids and a younger appearance at 6 mo
Rossi et al[30], 2018	Plasma exeresis	Prospective, controlled, evaluator-blinded	Both	10	Change in the conformation of the collagen fibers from huddled and coalesce presentation to long and straight fibers
Giroux et al[33], 2019		Prospective, single center	Upper	25	About 2.5 mm of mean reduction at 12 mo follow-up
Theppornpitak et al[35], 2019		Prospective, controlled, evaluator-blinded	Both	18	Effective and safe for treatment of mild-to-moderate periorbital wrinkles and darkening
Verner et al[32], 2020		Prospective, single center	Upper	17	All patients had an improvement of dermathocalasis scale
Baroni[2], 2020		Prospective, single center	Upper	10	General satisfaction for the patients (8 or more on VAS scale) and the absence of permanent side effects
Ziade and Desiree[29], 2020		Case report	Both	2	Safe and efficient non-surgical option. Few complications; hyperpigmentation is the most common, preventable whit small precautions
Ferreira et al[31], 2021		Observational	Upper	16	General post-treatment satisfaction (modified Q-bleph) and limited adverse events
Martín-Oviedo et al[38], 2013	HA	Retrospective	Upper	26	Effective in reducing paralytic lagophthalmos and controlling keratopathy in patients with temporary facial palsy
Romero et al[42], 2013		Retrospective	Lower	12	Retraction was completely corrected in 96.3% of patients; improvement of the standardized MRD2 of 0.84 mm immediately after injection and 1.19 mm 9 mo later
Kohn et al[39], 2014		Prospective, non-randomized	Upper	8	HA injection may be an effective and minimally invasive method to improve upper eyelid position for patients with mild eyelid retraction in both the active and inactive stages of TED
Romeo[12], 2016		Cohort, prospective	Upper	154	Upper eyelid area filling with HA was compared to surgical blepharoplasty as means of reaching eye rejuvenation. The study showed high patient satisfaction in regards of the aesthetic endpoint and long lasting results in a 12 mo period
Jiang et al[47], 2016		Retrospective, single center clinical study	Lower (tear-trough deformity)	78	Compared the use of HA to autologous fat injections. Fillers may be used alone in the treatment of TTD in patients with mild to moderate periorbital volume loss without severe orbital fat bulging
Romeo[46], 2019		Retrospective	Upper	500	Upper eyelid area filling with HA was compared to surgical blepharoplasty as means of reaching eye rejuvenation. The study showed high patient satisfaction in regards of the aesthetic endpoint and long lasting results in a 12 mo period
Xi et al[42], 2019		Retrospective	Lower	27	Retraction was completely corrected in 96.3% of patients; improvement of the standardized MRD2 of 0.84 mm immediately after injection and 1.19 mm nine months later
Bladen and Malhotra[43], 2019		Retrospective, single center case review	Upper	8	6 patients showed improvement; HA injection is considered a feasible option for treatment of epibleharon
Mani et al[49], 2013	PMMA	Retrospective, single center	Lower	289	Subdermal PMMA microspheres injection is a safe technique in the correction of infraorbital rhytids
Amore et al[50], 2019	Deoxycholate	Multi-center, observational prospective	Lower fat pads	120	Moderate to high patient satisfaction and therapeutic success in 85.83% of the patients enrolled
Lee et al[51], 2020	Twisted polydioxanone threads	Retrospective, single center	Lower	40	More than 77.5% of patients were satisfied with the outcome
Aust et al[52], 2018	Platelet rich plasma	Prospective	Lower	20	Statistically significant increase in skin firmness and skin elasticity, high level of patient satisfaction, and progressive improvement of the aesthetic outcome

PMMA: Polymethylmethacrylate; HA: Hyaluronic acid; MRD2: Marginal reflex distance 2; TTD: Tear trough deformity; TED: Thyroid eye disease; VAS: Visual analogue scale.