Effects of Upper Eyelid Blepharoplasty on Perceived Attractiveness, Success, and Health

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Abstract

Materials and Methods

This study was approved by the Institutional Review Board of Gaziosmanpaşa Training and Research Hospital (No. 186-02.12.2020). All participants provided written informed consent, which were electronically secured, maintaining data confidentiality according to ethical standards. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

The study included Turkish-speaking adults over the age of 18 years, excluding minors and individuals with psychiatric conditions like schizophrenia or autism, which could affect facial perception. Responses were excluded if the survey was not completed in full.

Photographs were taken under controlled settings before and 6 months after upper eyelid blepharoplasty to ensure consistency across all images. Uniform lighting, camera settings, and backdrops were used to minimize biases associated with external variables. The postoperative images featured only patients who had not undergone any other facial procedures during the interim.

To select standardized patient images that accurately reflected typical candidates for blepharoplasty and the expected surgical outcomes, the Delphi method was employed. This involved a panel of experts who reviewed potential images in several rounds of evaluation, allowing consensus to be reached on the most representative photographs for use in the study.

Observers were randomly selected and tasked with evaluating these images using a validated visual analog scale from 0 to 10, where higher scores indicated more favorable perceptions. Observers assessed the perceived age of each individual by using a slider bar ranging from 30 to 90 years, with 1-year increments. Subsequently, they rated facial attractiveness on a scale from 0 (least attractive) to 10 (most attractive). Participants then evaluated the perceived success of the individual on a scale from 0 (complete failure) to 10 (extremely successful), followed by an assessment of perceived healthiness on a scale from 0 (extremely unhealthy) to 10 (extremely healthy). The observer rating questions and scale descriptions are shown in Table 1.

Table 1

Observer rating questions and scale descriptions

Each observer’s survey included images that were not paired, ensuring that preoperative and postoperative photos of the same patient were not presented together to avoid recognition bias. The sequence of the photographs was not disclosed to the observers to maintain an unbiased assessment. Demographic details, including any history of plastic surgery, were recorded for each observer.

Statistical analysis was performed using IBM SPSS ver. 21.0 (IBM Corp). Paired sample t-tests were applied as appropriate to compare changes in perceptions before and after surgery, with a significance level set at p < 0.05.

Results

The study was conducted between January and February 2022, with 203 observers completing the web-based survey. The demographic distribution of the observers included 108 women (53.2%) and 95 men (46.8%), with an age range of 18 to 61 years and a mean age of 34.06 ± 7.3 years. Notably, 39 observers (19.1%) had previously undergone plastic surgery, as shown in Table 2, which details the demographic characteristics of the sample.

Table 2

Demographic characteristics of observers

The analysis of the observer ratings revealed significant changes in perceived age following blepharoplasty. Prior to surgery, the mean estimated age was 51.75 ± 9.78 years, which decreased to 42.10 ± 9.34 years post surgery, indicating a statistically significant reduction (p = 0.01). This finding suggests that blepharoplasty led observers to perceive patients as being younger.

Further, there was no significant difference in the evaluations between observers who had undergone aesthetic surgery themselves and those who had not (p = 0.01), suggesting that personal experience with plastic surgery did not bias the assessments of the patients.

Table 3 outlines the changes in observer ratings for attractiveness, perceived success, and overall health. Postoperative assessments showed that patients who underwent upper eyelid blepharoplasty were rated higher on mean attractiveness scores, perceived success, and overall health compared to their preoperative ratings. These increases were statistically significant and highlight the positive impact of the surgical intervention on observer perceptions.

Table 3

Observer evaluations

Discussion

In this investigation, observers who were unaware of the patients’ surgical status perceived individuals in postoperative images of upper eyelid blepharoplasty as significantly younger, more attractive, more successful, and healthier. This aligns with previous studies on facial aesthetics, which suggest that cosmetic enhancements can substantially alter public perception [6,7].

Our findings contribute uniquely to the literature, as this is, to our knowledge, the first study focusing exclusively on upper eyelid blepharoplasty. The results indicate that this procedure not only reduces age appearance but also enhances perceived personal success and health, likely improving interpersonal interactions.

The negative social impacts of conditions like blepharosalacia and dermatosalacia, which can detrimentally affect first impressions by making individuals appear older and more fatigued, were highlighted in research by Bullock et al. [8]. Our study extends these observations by showing that corrective surgery can inversely improve such perceptions. Similarly, widening the palpebral aperture has been demonstrated to make patients look less tired and more engaged, suggesting enhancements in how their personalities are perceived [9,10]. The study by Reilly et al. [11] further supports this, with findings that patients undergoing lower eyelid surgery appeared more attractive and trustworthy post operation.

Research has consistently shown that attractiveness can confer numerous advantages in social situations, with more attractive individuals perceived as having more desirable personalities and leading more successful lives [12,13]. Our study suggests that upper eyelid blepharoplasty can contribute to these perceptions, supporting findings from a study by Jones et al. [14], which showed increased confidence and perceived cuteness post surgery. One study found that attractive people have more socially desirable personalities, live happier lives, and experience more success than less attractive people [15]. Supporting our study, research examining the outcomes of facial cosmetic surgery showed that patients who underwent upper eyelid blepharoplasty appeared cuter and more confident after the surgery [16]. While blepharoplasty is typically aimed at rejuvenating appearance, our findings illuminate broader implications for a patient’s social interactions and personal satisfaction.

However, this study has certain limitations. While the participant pool of observers was balanced in terms of sex, it was limited in size and included only female patients. Future research could address these limitations by incorporating a larger and more diverse sample of both observers and patients, thereby enhancing the generalizability of the findings and confirming the promising results observed in this study.

In conclusion, this study demonstrates that upper eyelid blepharoplasty significantly enhances perceptions of attractiveness, health, and success, confirming the profound impact of cosmetic surgery on social perceptions.

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