This prospective randomized contralateral comparative study aims to compare electrocautery and scalpel incision techniques in upper eyelid blepharoplasty. Each participant undergoes bilateral upper eyelid blepharoplasty, with one eyelid randomized to electrocautery incision and the contralateral eyelid to scalpel incision. Outcomes include postoperative pain, edema, ecchymosis, scar quality, wound healing, patient satisfaction, and surgeon satisfaction. The study is designed to determine whether electrocautery provides comparable or superior clinical outcomes while maintaining safety and surgical effectiveness.
Upper eyelid blepharoplasty is one of the most commonly performed oculoplastic procedures. The skin incision can be made using either a conventional scalpel or electrocautery. Electrocautery may reduce intraoperative bleeding and improve visualization of the surgical field; however, concerns remain regarding thermal tissue injury, wound healing, scar formation, and postoperative outcomes. This is a prospective, randomized, contralateral comparative clinical study. Adult patients undergoing bilateral upper eyelid blepharoplasty are enrolled. In each participant, one eyelid is randomly assigned to incision with electrocautery and the contralateral eyelid to incision with a scalpel, allowing each patient to serve as their own control and minimizing inter-individual variability. Postoperative evaluations are performed at predefined follow-up visits. Primary and secondary outcome measures include postoperative pain, eyelid edema, ecchymosis, wound healing, scar quality, patient satisfaction, surgeon satisfaction, operative time, and procedure-related complications. Safety outcomes include the occurrence of adverse events such as infection, wound dehiscence, delayed healing, hematoma, or other surgery-related complications. The objective of the study is to determine whether electrocautery incision is a safe and effective alternative to conventional scalpel incision for upper eyelid blepharoplasty.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
60
Skin incision performed using electrocautery during upper eyelid blepharoplasty.
Skin incision performed using a scalpel during upper eyelid blepharoplasty.
University of Health Sciences Beyoğlu Eye Training and Research Hospital
Istanbul, Istanbul, Turkey (Türkiye)
Skin excision time
Time required for skin incision and excision, measured separately for each eyelid from the initial skin incision to completion of planned skin excision using a digital stopwatch. Lower values indicate greater operative efficiency.
Time frame: During surgery (intraoperative)
Intraoperative bleeding
Intraoperative bleeding was assessed separately for each eyelid by measuring the total number of cotton-tipped applicators used for hemostasis during skin incision and tissue dissection. A lower number indicated less intraoperative bleeding.
Time frame: During surgery (intraoperative)
Postoperative ecchymosis
Postoperative ecchymosis was assessed from standardized photographs using ImageJ software. The ecchymotic area was measured in square centimeters and graded on a 5-point scale (0 = no ecchymosis; 1 = ≤2 cm²; 2 = \>2-4 cm²; 3 = \>4-6 cm²; 4 = \>6 cm²). Lower scores indicated less postoperative ecchymosis.
Time frame: Postoperative day 1, week 1, month 1, month 3, and month 6
Postoperative edema
Postoperative eyelid edema was evaluated using a standardized 5-point grading scale (0 = none; 1 = minimal; 2 = edema extending to the iris; 3 = edema covering the iris; 4 = upper and lower eyelids swollen shut). Lower scores indicated less postoperative edema.
Time frame: Postoperative day 1, week 1, month 1, month 3, and month 6
Scar visibility
Scar visibility was evaluated by masked observers using standardized postoperative photographs and graded on a 4-point ordinal scale (1 = invisible; 2 = mildly visible; 3 = moderately visible; 4 = highly visible). Lower scores indicated better scar appearance.
Time frame: Postoperative months 1, 3, and 6
Hyperpigmentation and hypopigmentation
Postoperative hypopigmentation and hyperpigmentation were evaluated separately for each eyelid using standardized postoperative photographs and recorded as present or absent by masked observers.
Time frame: Postoperative months 1, 3, and 6
Corneal epithelial staining
Corneal epithelial staining was evaluated using the Oxford grading scale (0-5) during slit-lamp examination. Higher scores indicated more severe corneal epithelial damage.
Time frame: Postoperative day 1, week 1, month 1, month 3, and month 6
Global Aesthetic Improvement Scale (GAIS)
Global aesthetic improvement was assessed by masked observers using the Global Aesthetic Improvement Scale (GAIS), a 5-point scale ranging from 1 (worse) to 5 (very much improved), based on comparison of postoperative and preoperative photographs.
Time frame: Postoperative day 1, week 1, month 1, month 3, and month 6
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