Smartphone Evaluation of Dynamic and Static Naturalness After Double-Eyelid Blepharoplasty.

Background: Recent studies on post-operative measurements for upper blepharoplasty utilized static photographs, which fail to accurately reflect the post-surgical dynamic naturalness of the eyelids.

Objectives: This study aimed to analyze dynamic naturalness after double-eyelid blepharoplasty using a simple smartphone method involving slow-motion videos.

Methods: This prospective observational study enrolled patients who underwent double-eyelid blepharoplasty using the flexible suspension technique (FST) and rigid fixation technique (RFT) and individuals with congenital double-eyelids. Demographic information was collected, and super-slow-motion videos of the eye-opening processes were recorded using a smartphone. Four keyframes were selected from each video, from which several parameters were measured. A third party evaluated the degree of naturalness of the photographs and eye-opening videos.

Results: Sixty women (20 per group) were enrolled. The fold-emerging delay (FED) score showed a linear correlation with the mean third-party dynamic naturalness rating (DNR) (R2=0.71, p<0.0001). The Puffy score showed a linear correlation with the mean third-party static naturalness rating (SNR) (R2=0.53, p<0.0001). For the congenital, FST, and RFT groups, respectively, the FED scores were 62.9±18.9, 52.2±17.7, and 26.3±18.3 (all p<0.05), the Puffy scores were 49.8±11.9, 55.9±11.0, and 62.6±12.4 (Congenital vs FST, p=0.055; others p<0.05), the mean third-party DNRs were 3.21±0.67, 2.47±0.62, and 1.78±0.74 (all p<0.0001), and the mean third-party SNRs were 3.01±0.78, 2.61±0.55, and 2.14±0.69 (all p<0.05).

Conclusions: The two new indices obtained from the analysis of smartphone-captured super-slow-motion videos are good indicators of dynamic naturalness of double-eyelids created using upper blepharoplasty.