Blepharoplasty consistently ranks among the most popular cosmetic services sought by both men and women, with more than 200 000 procedures performed in 2015. Although blepharoplasty is commonly regarded as a procedure to rejuvenate the aging face, for some individuals, visual impairment due to dermatochalasis makes blepharoplasty medically necessary to restore visual functioning. Despite the prevalence of this procedure, there exists little evidence aimed at quantifying the surgical effect of blepharoplasty.
The eyes play a crucial role in social functioning, as they can provide cues to social contacts indicating interest and engagement.Therefore, changes in the appearance of the eyes may affect these daily interactions. Age-related changes are known to alter the appearance of the eyes; excess eyelid skin, fat herniation, and wrinkles around the eyes have all been noted to signal aging. Previous efforts to measure the effect on perceived age of surgery for the aging face found that blepharoplasty yields a mean age reduction of 2 years. Aging has also been shown to be associated with decreasing ratings of attractiveness, which may have broader social implications.
Fatigue is also appreciated in changes in the appearance of the eyes. When individuals are asked to judge how fatigued an individual appears, they spend most of their time fixating on the eyes. A study exploring the specific cues for fatigue cited hanging eyelids, dark circles, and more wrinkles and fine lines. Interestingly, a primary concern of patients before they undergo blepharoplasty is that they appear tired, and fatigue is one of the major patient-reported outcomes captured on the Blepharoplasty Outcomes Evaluation (BOE) questionnaire. Furthermore, understanding how blepharoplasty changes ratings of energy level will prove important, as a 2016 survey by the American Academy of Facial Plastic and Reconstructive Surgery uncovered a new trend: patients are seeking procedures with the hopes of appearing less tired.
The appearance of fatigue has also been shown to cause decrements in ratings of perceived attractiveness and health, which further links the appearance of the eyes to social functioning. Individuals who are considered to be more attractive have been shown to receive preferential treatment in a variety of social and professional settings. From an evolutionary perspective, increases in perceived health may prove beneficial in mate selection. These associations provide further incentive for patients to reverse the appearance of fatigue.
The primary objective of this study was to measure the effect of blepharoplasty on several facial perception domains. We aimed to quantify the effect of surgery on the traditional domains of age and attractiveness, and also explored how surgery can affect ratings of perceived health and fatigue. Understanding these clinical effect sizes will position surgeons well to guide patient expectations before the procedure. Furthermore, we explored patient-reported ratings of fatigue before and after blepharoplasty. By examining ratings of fatigue from both the patient and the observer perspective, physicians will be better able to counsel patients regarding this important domain.
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