Comparison of Corneal Surface Symmetry and Optical Aberrations after Conventional versus Brassiere Suture Technique in Upper Eyelid Blepharoplasty

To compare the effects of conventional blepharoplasty and the brassiere suture technique on corneal topography and optical aberrations.

This retrospective comparative study included right eye data from 140 patients who underwent upper eyelid blepharoplasty for dermatochalasis between 2023 and 2025. Patients were divided into two groups based on the surgical technique: conventional blepharoplasty (n = 80) and brassiere suture technique (n = 60). Corneal topography and aberrometry were assessed preoperatively and at 3 months postoperatively using the Sirius topography system. Pre- and postoperative changes in 40 parameters were analyzed using the Wilcoxon signed-rank test, and intergroup comparisons of delta values (Δ) were performed using the Mann-Whitney U-test.

Neither technique resulted in significant changes in most corneal topography or aberrometry parameters (P > 0.05). However, the brassiere suture group demonstrated significant improvements in the superior irregularity ratio (ΔSIR) and total symmetry index (ΔTSI) (P = 0.006 and P = 0.018, respectively). In addition, a significant reduction was observed in vertical trefoil aberration at 6 mm (ΔTrefoil vertical, P = 0.031). No significant intergroup differences were found in other aberration or keratometric parameters.

The brassiere suture technique demonstrated statistically significant improvements in corneal symmetry (SIR) and regularity (TSI) compared to conventional blepharoplasty. These findings indicate that the surgical approach may influence corneal surface characteristics. Further prospective studies are warranted to assess the clinical relevance of these optical changes.