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

Recent studies on postoperative measurements for upper blepharoplasty utilized static photographs, which fail to accurately reflect the postsurgical dynamic naturalness of the eyelids.

In this study we aimed to analyze dynamic naturalness after double-eyelid blepharoplasty with a simple smartphone method involving slow-motion videos.

In this prospective observational study we enrolled patients who underwent double-eyelid blepharoplasty with the flexible suspension technique (FST) and rigid fixation technique (RFT), and individuals with congenital double eyelids. Demographic information was collected, and ultra-slow-motion videos of the eye-opening processes were recorded with 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.

Sixty females (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 < .0001). The puffy score showed a linear correlation with the mean third-party static naturalness rating (SNR) (R2 = 0.53, P < .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 < .05); the puffy scores were 49.8 ± 11.9, 55.9 ± 11.0, and 62.6 ± 12.4 (congenital vs FST, P = .055; others P < .05); the mean third-party DNRs were 3.21 ± 0.67, 2.47 ± 0.62, and 1.78 ± 0.74 (all P < .0001); and the mean third-party SNRs were 3.01 ± 0.78, 2.61 ± 0.55, and 2.14 ± 0.69 (all P < .05).

The 2 new indices obtained from the analysis of smartphone-captured ultra-slow-motion videos are good indicators of the dynamic naturalness of double eyelids created with upper blepharoplasty.