Blepharoplasty Publications Lack Evidence-Based Research

Close up of the face of a patient undergoing blepharoplasty. The surgeon cuts the eyelid and performs manipulations using medical instruments
Close up of the face of a patient who is undergoing blepharoplasty. The surgeon cuts the eyelid and performs manipulations using medical instruments.
In a review of the top 100 studies on blepharoplasty, few had an acceptable level of evidence.

More, robust research about blepharoplasty is needed to guide clinical practice, according to a systematic review published in Ophthalmic Plastic and Reconstructive Surgery.

Investigators at multiple Universities in the United Kingdom searched publication databases through March 2021 for studies of blepharoplasty. Publications were ranked by total citations. The top 100 most cited articles were reviewed for trends.

Most of the papers (n=93) were single center studies conducted in the United States (n=80). The decade with the highest publication rate was the 1990s (n=41). Most publications were case series, followed by expert opinions, narrative reviews, retrospective cohort studies, prospective cohort studies, case reports, cross-sectional studies, systematic reviews, simulation studies, nonclinical studies, and randomized controlled trials.

Of note, the 2 most prolific authors, Clinton D. McCord Jr, MD, and Mark A. Codner, MD, who were first authors on 5 and 1 and coauthors on 2 and 5 articles, respectively, were coeditors of Eyelid and Periorbital Surgery.

Collectively, the papers cited 4194 other articles, which were studies about plastic surgery (n=3764), ophthalmic or oculoplastic surgery (n=2685), and other combined specialties (n=1608).

The studies frequently presented level 4 (n=51) or 5 (n=35) evidence. No improvement in the level of evidence was observed with time.

Most studies did not declare a funding source (n=87) or were not funded (n=7).

The papers focused on modifying the blepharoplasty procedure (n=65) or improving cosmetics of periocular rejuvenation (n=30). The studies with outcome-based measurements (n=17) focused on safety outcomes (n=12), of which eight used objective cosmetic outcomes instead of validated measures and only two used the validated Blepharoplasty Outcomes Evaluation (BOE).

A potential limitation of this review was that there tends to be recognition bias, in which time passes between publication and citation accruement, so this review may not have included more recently published papers.

“The 100 most highly cited papers on blepharoplasty largely presented lower Oxford Centre for Evidence-Based Medicine levels of evidence, which limits their generalizability and wider applicability. High-quality studies embodying reproducible methodology are needed to satisfy increasing demands for robust evidence to enhance shared decision-making. These should consider the adoption of validated outcome measures, which facilitate the interpretation and comparison of results by an international audience. Future studies that overcome these challenges will firmly establish blepharoplasty as an evidence-based procedure in the oculoplastic surgeon’s operative toolbox,” according to the study authors.

Disclosure: One author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Charles WN, Lim HK, Charles RC, et al. Evidence-based blepharoplasty: an analysis of highly cited research papers. Ophthalmic Plast Reconstr Surg. 2022;38(4):325-329. doi:10.1097/IOP.0000000000002087