Early Physiological Markers of Wound Healing as Potential Prognostic Markers of Long-Term Patient Satisfaction After Upper Eyelid Blepharoplasty: A Comparative Analysis of Aloe Vera Versus Untreated Controls

Background While topical Aloe Vera has been shown to improve wound healing following upper eyelid blepharoplasty, it remains unknown which early physiological markers of healing best predict long-term patient satisfaction. Identifying such predictors could help surgeons counsel patients and optimize postoperative protocols. Objective The objective of this study is to determine which early wound-healing parameters (vascularity, pigmentation, pliability, and height) measured at one week postoperatively are most strongly associated with patient satisfaction at three months after upper eyelid blepharoplasty and to compare these associations between Aloe Vera-treated and untreated wounds. Methods This was a secondary analysis of data from a split-face, assessor-blinded, randomized controlled trial involving 10 patients (20 surgical sites) undergoing bilateral upper eyelid blepharoplasty. One eyelid received topical Aloe Vera gel once daily for seven days postoperatively; the contralateral side served as an untreated control. Scar characteristics were assessed using the modified Vancouver Scar Scale (mVSS) at one week and three months. Patient satisfaction was measured using a five-point Likert scale at three months. Spearman's rank correlation coefficients were calculated to examine associations between early (one week) mVSS parameters and late (three months) satisfaction. Multivariable ordinal logistic regression was performed to identify independent prognostic markers of satisfaction. Results In Aloe Vera-treated wounds, the total mVSS score at one week showed a very strong negative correlation with patient satisfaction at three months (r = -0.88; P = 0.002). Among individual parameters, vascularity at one week demonstrated the strongest correlation with subsequent satisfaction (r = -0.82; P = 0.004), followed by pigmentation (r = -0.79; P = 0.009). In untreated control wounds, correlations were weaker and non-significant for most parameters (P > 0.05 for all comparisons). Conclusion Early physiological response to Aloe Vera therapy, particularly reduction in vascularity and pigmentation within the first postoperative week, is strongly associated with patient satisfaction at three months following upper eyelid blepharoplasty. These findings provide surgeons with evidence-based prognostic markers for counseling patients and suggest that early wound appearance may serve as a reliable indicator of final aesthetic outcomes when Aloe Vera is used as an adjunctive therapy.