A Systematic Preoperative Evaluation and Skin Excision Design for Incisional Blepharoplasty.

[BACKGROUND] The prevalence of skin redundancy and lack of creases in the Asian upper eyelids makes blepharoplasty popular. Although many incision designs have been developed to improve upper eyelid laxity, there is a lack of a universal method to match various upper eyelid conditions. We present a systematic preoperative evaluation and design approach that incorporates eye esthetics to determine the shape and amount of skin to be removed to create attractive eyes.

[METHODS] A retrospective review of 352 patients who underwent incisional blepharoplasty from May 2020 to May 2022 was performed. The excised area was determined preoperatively according to the degree of upper eyelid skin laxity, and the best of the three precise designs is chosen.

[RESULTS] All patients undergoing the procedure achieved a satisfactory eyelid appearance immediately after surgery. Patients were followed up for 3 to 12 months. All patients had significant improvement in upper eyelid skin laxity and a natural shape of the eyelid. No defects that required revision surgery to improve were present, and 91.7% of the patients were satisfied with the long-term outcome.

[CONCLUSIONS] This systematic approach to preoperative design is simple, effective, and feasible to avoid scar exposure while addressing the lateral hood and achieve an attractive blepharoplasty appearance.