A dual approach to understanding facial perception before and after blepharoplasty

Kristin L. Bater, Masaru Ishii, Jason C. Nellis, Andrew Joseph, Ira D. Papel, Theda C. Kontis, Patrick J. Byrne, Kofi D.O. Boahene, Lisa E. Ishii

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


IMPORTANCE Blepharoplasty consistently ranks among the most common facial plastic surgery procedure sought by both men and women. Despite the popularity of blepharoplasty, there has been little research focused on quantifying how eyelid surgery changes facial perceptions. OBJECTIVES To quantify the effect of blepharoplasty on facial perceptions and measure patient-reported ratings of fatigue before and after surgery to compare observer and patient perceptions. DESIGN, SETTING, AND PARTICIPANTS Aweb-based survey experimentwas conducted from January to February 2017, featuring photographs of female patients before and after blepharoplasty. Observers were randomly shown independent images of each patient and asked to rate perceived age, attractiveness, health, and energy level. Respondents saw only preoperative or postoperative photographs of each patient to reduce bias due to priming. Patient-reported outcomes were also collected. MAIN OUTCOMES AND MEASURES A multivariate mixed effects regression modelwas used to quantify the changes in each domain after surgery. Ordinal rank change was calculated to provide a measure of clinical effect size across the domains. To analyze patient-reported outcomes, a Kruskal-Wallis test followed by Mann-Whitney tests were performed to determine if there were differences in patient-perceived tiredness based on operative status. RESULTS A total of 401 participants (243 women, 152 men, and 6 not specified; mean age 25.9 years [range, 18-73 years]) successfully completed the survey and evaluated before-and-after photographs of 10 female patients (mean age, 59.8 years). The multivariable mixed effects model revealed that individuals are perceived as appearing significantly younger (-1.04 years; 95%CI, -1.70 to -0.37 years) and more attractive (coefficient, 4.92; 95%CI, 3.91-5.93) after blepharoplasty. Ratings of perceived health (coefficient, 4.33; 95% CI, 3.28-5.37) and energy level (coefficient, 9.83; 95%CI, 8.51-11.16) also improved significantly. After undergoing blepharoplasty, patients had significantly improved ratings of energy level compared with those who had not undergone blepharoplasty. CONCLUSIONS AND RELEVANCE This is the first study, to date, aimed at quantifying the perceptions of facial aesthetic changes following blepharoplasty. The data demonstrate that individuals are rated as appearing more youthful, attractive, and healthy following blepharoplasty. Furthermore, both patients and casual observers perceived a significant improvement in energy level following blepharoplasty, a meaningful finding as the appearance of fatigue is a chief concern of the patients before they undergo blepharoplasty. LEVEL OF EVIDENCE NA.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJAMA Facial Plastic Surgery
Issue number1
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Surgery


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