Upper Eyelid Blepharoplasty Reduces Perceived Age: An Artificial Intelligence-Based Analysis

Upper eyelid blepharoplasty is a commonly performed procedure for periorbital rejuvenation; however, objective evaluation of its aesthetic outcomes remains limited. This study aimed to assess changes in perceived age following upper blepharoplasty using an artificial intelligence (AI)-based age estimation model. In this retrospective cohort study, patients who underwent isolated upper blepharoplasty between January 2022 and January 2025 were included. Standardized preoperative and postoperative (3-6 mo) facial photographs were analyzed using a multimodal AI system. Each image was evaluated 3 times with a standardized prompt, and mean values were recorded. The primary outcome was the change in perceived age. A total of 47 patients were included (mean chronological age: 48.77±7.74 y). The mean AI-estimated age decreased from 48.57±7.30 years preoperatively to 43.74±7.00 years postoperatively, corresponding to a mean reduction of 4.83 years (P<0.001; Cohen d=3.60). Preoperative AI estimates showed close agreement with chronological age (mean difference: -0.19 y), whereas postoperative estimates demonstrated a significant underestimation (-5.02 y; P<0.001). The mean absolute error increased from 1.77 years preoperatively to 5.15 years postoperatively. Bland-Altman analysis confirmed minimal bias before surgery and a systematic negative bias after surgery, indicating a shift toward younger age estimation. These findings suggest that upper eyelid blepharoplasty results in a measurable reduction in perceived age. AI-based facial analysis may provide an objective and reproducible tool for evaluating outcomes in aesthetic facial surgery.