Is blepharoplasty more than a cosmetic procedure? Quantitative analysis of cutaneous changes in eyelid skin and clinical effects in elderly patients with dermatochalasis

To quantitatively evaluate changes in eyelid skin lipid and moisture indices using a digital skin analyzer, which is a portable device that uses the biological impedance method for measuring skin moisture and lipid levels, and to determine the clinical efficacy of blepharoplasty in managing refractory blepharitis among elderly patients with dermatochalasis through a retrospective analysis of medical records. This retrospective clinical study analyzed the medical records of patients aged 60–80 years who were diagnosed with blepharitis during clinical examination when admitted for blepharoplasty due to dermatochalasis. Sixty patients with an insufficient response to conventional medical treatment were included through chart review. All patients had undergone upper eyelid blepharoplasty. Clinical evaluations were retrospectively analyzed from preoperative records and third-month postsurgical follow-up documentation. The primary outcome measure was obtained from archived portable digital skin analyzer data using biological impedance methodology, which had been used to quantitatively assess eyelid skin lipid and moisture indices. Secondary evaluations included retrospective analysis of documented Ocular Surface Disease Index (OSDI) scores, tear film break-up time (TBUT), and Oxford staining scores for comprehensive assessment. Analysis of digital skin analyzer measurements demonstrated significantly reduced lipid and moisture indices in the eyelid skin following surgery ( p = 0.0275 and p = 0.0381, respectively), providing objective evidence of quantifiable cutaneous alterations. These changes were accompanied by notable clinical improvements, evidenced by significant improvements in OSDI scores ( p < 0.001) and TBUT values ( p = 0.0471). While Oxford staining scores showed a trend toward improvement, these changes did not achieve statistical significance ( p = 0.0628). In patients who had previously demonstrated resistance to topical therapy, clinical signs of blepharitis were documented as improved in the postoperative records. The present study observed quantifiable alterations in pretarsal eyelid skin bioimpedance indices alongside symptomatic and ocular surface improvements following functional blepharoplasty in elderly patients with dermatochalasis and concurrent refractory blepharitis. Beyond its established functional benefits for visual field restoration, the alleviation of anatomical skin redundancy may favorably alter the local eyelid microenvironment. The observed reductions in pretarsal skin lipid and moisture indices provide a preliminary basis for the hypothesis that surgical debulking could indirectly influence microbial or parasitic colonization, such as Demodex mites, and bacterial lipase activity. However, these proposed biological mechanisms remain hypothetical and require future validation through prospective studies incorporating direct microbiological and acarological quantification.