Functional and aesthetic outcomes following upper eyelid blepharoplasty: A systematic review and meta-analysis of contemporary oculoplastic techniques

Introduction: Upper eyelid blepharoplasty is a common oculoplastic procedure addressing dermatochalasis-related functional deficits and aesthetic concerns. Recent advances, including fat-preserving and septal-tightening techniques, aim to optimize results, yet comparative data remain inconsistent.Objective: To evaluate functional, aesthetic, and safety outcomes of contemporary blepharoplasty techniques compared with traditional excisional methods.Methods: Following PRISMA 2020 and Cochrane v6.4 guidelines, five databases were searched (2000–2025). Eligible studies involved adults (≥18 years) undergoing upper blepharoplasty with quantitative outcome reporting. Primary measures included Margin Reflex Distance 1 (MRD1), superior visual field (SVF), and patient satisfaction. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models.Results: From 1,326 records, 42 studies qualified and 28 entered meta-analysis. Blepharoplasty produced significant improvements in MRD1 (SMD 1.62, 95% CI 1.21–2.03), SVF (SMD 1.74, 95% CI 1.29–2.18), and satisfaction (SMD 2.04, 95% CI 1.57–2.52; p < 0.001). Fat-preserving and septal-tightening methods outperformed traditional excisional approaches (p = 0.02). Complication rates were low (5.2%), with no publication bias detected (p = 0.19).Conclusion: Upper blepharoplasty provides substantial functional and aesthetic benefits with excellent safety. Fat-preserving and septal-tightening approaches yield superior, balanced outcomes, supporting their role as reconstructive techniques in modern oculoplastic practice.