Purpose

To evaluate the variability of preoperative upper blepharoplasty markings performed by different oculoplastic surgeons on standardized male and female subjects.

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Methods

Twenty-one oculoplastic surgeons independently marked the left upper eyelid of the exact same male (n=14) or female (n=7) model using an erasable white pencil. Between each surgeon’s assessment, previous markings were completely erased with wet gauze. No surgery was performed. Measurements included: lower incision (crease) height, upper incision height (measured from the lower incision), total excision area (mm²), lateral break angle (degrees), and lateral extension (mm). Surgeon experience and use of adjunctive tools were recorded.

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Results

For the male model, mean measurements were: excision area 263.90 ± 13.40 mm², inferior incision 7.62 ± 0.19 mm, upper incision 7.55 ± 0.39 mm, lateral break angle 111.9° ± 2.43°, and lateral extension 5.42 ± 0.34 mm. For the female model: excision area 215.58 ± 14.61 mm², inferior incision 8.18 ± 0.49 mm, upper incision 9.87 ± 0.83 mm, lateral break angle 103.2° ± 3.44°, and lateral extension 5.17 ± 0.32 mm. Surgeons marking the female subject had more experience (17.0 vs. 7.6 years); however, inter-surgeon variability remained consistently high. Notably, neither the surgeons’ years of experience nor their use of adjunctive tools showed any correlative trend or difference regarding the marking variations within the studied sample.

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Conclusion

To our knowledge, this is the first study evaluating inter-surgeon variability in blepharoplasty markings on the same in vivo models. While techniques differ significantly, basic foundational concepts are universally observed. Gender-specific aesthetic preferences and personal technique significantly influence marking strategies, independent of years of experience.

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Additional Authors

First name	Last name	Base Hospital / Institution
Marcelo	Velloso Fabris	Hospital de Clínicas de Porto Alegre

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