From Incision to Healing: An Evidence-Based Review of Scar Optimization in Upper Blepharoplasty

Abstract: Upper blepharoplasty is one of the most commonly performed aesthetic procedures, with scar quality being a critical determinant of patient satisfaction. This review evaluates various surgical and postoperative strategies to optimize cosmetic outcomes and minimize complications such as wound dehiscence, milia formation, and scarring. Various incision modalities (including cold scalpel, radiofrequency (RF), and CO₂ laser) have been evaluated for their impact on surgical precision, hemostasis, and cosmetic results. Comparative studies have shown no significant difference in final scar appearance or aesthetic outcomes between these methods.Multiple studies have compared different suture types in blepharoplasty. Interrupted cutaneous sutures and subcuticular suture demonstrate less early ecchymosis and better short-term scar scores than running techniques. The role of “tension relief” in preventing lateral wound dehiscence has also been emphasized. In terms of suture material, absorbable and non-absorbable sutures yield comparable healing and scarring outcomes, although absorbables may eliminate the need for removal. Topical agents such as silicone-based creams show consistent benefits in reducing hypertrophic scarring.There is insufficient evidence to support the routine use of botulinum toxin and triamcinolone in upper eyelid surgery. Postoperative modalities including cold compresses, compressive dressings, and over-the-counter anti-scar medications show minimal clinical benefit and may be omitted without compromising outcomes. In conclusion, optimal outcomes following upper blepharoplasty depend on meticulous surgical technique, individualized suture selection, effective tension management, and evidence-based postoperative care. The routine use of several widely practiced interventions lacks scientific backing and should be reconsidered in favor of strategies with proven efficacy. No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.