A split-face comparison of cold compress application and electrocautery in upper eyelid blepharoplasty

Abstract

Aims: To compare the effects of intraoperative electrocautery and cold compress application on postoperative edema and ecchymosis in upper eyelid blepharoplasty using a split-face design. Methods: This prospective, observer-blinded, split-face study included 45 patients (90 eyelids) who underwent bilateral upper eyelid blepharoplasty. In each patient, the right eyelid was treated with electrocautery, in which haemostasis was achieved using bipolar cautery, while the contralateral left eyelid was treated with cold compress application, in which sterile cold compresses were applied for bleeding control without the use of cautery. Postoperative edema and ecchymosis were assessed at the 1-hour, 1-day, and 1-week postoperative time points using standardized photographs evaluated by a blinded observer. The severity of edema and ecchymosis was graded using a 5-point scale. Given the paired nature of the split-face design, statistical analyses were performed using the Wilcoxon signed-rank test, and a p value <0.05 was considered statistically significant. Results: Of the 45 patients, 32 (70.7%) were male and 13 (29.3%) were female, with a mean age of 46.7±8.5 years. When edema parameters were compared between electrocautery-treated and cold compress-treated eyelids, edema scores were numerically higher in the electrocautery-treated eyelids at all postoperative time points; however, these differences were not statistically significant (p>0.05 for all comparisons). In contrast, ecchymosis scores were significantly lower in the electrocautery-treated eyelids at the 1-hour postoperative assessment (p=0.03), whereas no statistically significant differences were observed at the 1-day and 1-week evaluations (p>0.05 for both). Conclusion: Intraoperative cold compress application resulted in postoperative edema and ecchymosis outcomes comparable to those achieved with electrocautery during upper eyelid blepharoplasty. Within the limitations of this exploratory split-face study and short-term follow-up, cold compress may be considered a tissue-sparing adjunct in selected cases, particularly beyond the immediate postoperative period. Larger, prospective studies incorporating long-term outcomes and patient-reported measures are warranted to further define its clinical role.

Keywords

• Blepharoplasty
• cold temperature
• ecchymosis
• edema
• electrocautery
• haemostasis

Üst Göz Kapağı Blefaroplastisinde Soğuk Kompres Uygulaması ve Elektrokoterizasyonun Karşılaştırmalı Analizi

Abstract

Amaç: Split-face tasarım kullanılarak üst göz kapağı blefaroplastisinde intraoperatif elektrokoter ve soğuk kompres uygulamasının postoperatif ödem ve ekimoz üzerindeki etkilerini karşılaştırmak. Yöntemler: Bu prospektif, randomize, gözlemci kör çalışmaya bilateral üst blefaroplasti uygulanan 45 hasta (90 göz kapağı) dahil edildi. Her hastada sağ göz kapağı bipolar koter ile hemostaz sağlanan **elektrokoter grubunu**, sol göz kapağı ise koter kullanılmaksızın kanama kontrolü için steril soğuk kompres uygulanan **soğuk kompres grubunu** oluşturdu. Postoperatif ödem ve ekimoz, standartize fotoğraflar üzerinden kör bir gözlemci tarafından 1. saat, 1. gün ve 1. haftada değerlendirildi. Her iki parametre için şiddet 5 puanlık bir skalada derecelendirildi. İstatistiksel analizlerde Mann–Whitney U testi kullanıldı ve p < 0,05 anlamlı kabul edildi. Bulgular: Kırk beş hastanın 32’si (%70,7) erkek, 13’ü (%29,3) kadındı ve ortalama yaş 46,7 ± 8,5 yıl idi. Tüm postoperatif zaman noktalarında ödem skorları elektrokoter grubunda daha yüksek saptanırken, ekimoz skorları 1. saatte ve 1. günde soğuk kompres grubunda hafifçe daha düşük izlendi. Ancak bu farkların hiçbiri istatistiksel olarak anlamlı değildi (tüm karşılaştırmalar için p > 0,05). Sonuç: Üst göz kapağı blefaroplastisinde intraoperatif soğuk kompres uygulaması, elektrokoter ile karşılaştırılabilir düzeyde hemostatik etkinlik ve postoperatif sonuçlar sağlar ve ödem veya ekimozu artırmaz. İstatistiksel olarak üstün olmasa da, özellikle termal hasarın en aza indirilmesinin istendiği olgularda soğuk kompres güvenli ve dokuya daha az travmatik bir alternatif olarak düşünülebilir. Bu bulguların doğrulanması için daha geniş örneklemli, çok merkezli çalışmalara ihtiyaç vardır.

Keywords

• blefaroplasti
• soğuk kompress
• ekimoz
• ödem
• elektrokoter
• hemostaz

References

1. Codner MA, Kikkawa DO. Blepharoplasty and eyelid surgery: principles and practice. Springer, 2016.
2. Rohrich RJ, Janis JE, Fagien S, Stuzin JM. Blepharoplasty: expert consult. Elsevier, 2011.
3. McCord CD, Codner MA. The role of cautery in upper blepharoplasty: minimizing collateral tissue damage. Plast Reconstr Surg. 2008;122(4): 1281-1287.
4. Kerr-Valentic MA. The role of hypothermia in controlling surgical bleeding. J Surg Res. 2009;153(1):23-30.
5. Lelli GJ Jr, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg. 2010;125(3):1007-1017. doi:10.1097/PRS.0b013e3181ce17e8
6. Shin YS, Lim N Y, Yun S C, Park K O. A randomised controlled trial of the effects of cryotherapy on pain, eyelid oedema and facial ecchymosis after craniotomy. J Clin Nurs. 2009;18(21):3029-3036. doi:10.1111/j.1365-2702.2008.02652.x
7. Kargi E, Hoşnuter M, Babucçu O, Altunkaya H, Altinyazar C. Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Ann Plast Surg. 2003;51(06):570-574. doi:10.1097/01.sap. 0000095652.35806.c5
8. Patel BC, Malhotra R. Blepharoplasty: anatomy, planning, techniques, and safety. Springer, 2018.

9. Holds JB, Massry GG, Patrinely JR. Avoiding and managing complications in blepharoplasty. Thieme, 2019.
10. Chen WP, Khan JA, McCord CD. The role of electrocautery in modern blepharoplasty: a systematic review. Ophthal Plast Reconstr Surg. 2015;31(4):265-270.
11. Spinelli HM, Jelks GW. Periocular rejuvenation: lower eyelid blepharoplasty with fat repositioning and the suborbicularis oculi fat. Plast Reconstr Surg. 2007;120(6):1755-1767.
12. Fagien S. Algorithm for cryogen treatment to reduce bruising and edema in aesthetic surgery. Aesthet Surg J. 2008;28(4):443-451.
13. Trepsat F. Periorbital rejuvenation combining fat grafting and blepharoplasties. Aesthetic Plast Surg. 2003;27(4):243-253. doi:10.1007/s00266-003-2126-y
14. Hamako M, Ono S, Ishii N, et al. Reduced thermal spread with advanced bipolar devices in eyelid surgery. J Plast Reconstr Aesthet Surg. 2016; 69(8):1134-1140.
15. Ernst E, Fialka V. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. J Pain Symptom Manage. 1994;9(1):56-59. doi: 10.1016/0885-3924(94)90150-3
16. Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? A systematic review. Br J Sports Med. 2010;44(3):179-187. doi:10.1136/bjsm.2009.065565
17. Nahai F, Saltz R, Kenkel JM. The art of aesthetic surgery: principles and techniques. 3rd ed. Thieme, 2017.
18. Massry GG, Murphy MR, Azizzadeh B. Master techniques in blepharoplasty and periorbital rejuvenation. Springer, 2011.
19. Goldberg RA, McCann JD, Shorr N, Baylis HI. The medical and surgical management of thyroid eye disease. Ophthalmology. 2002;109(3):427-431.
20. Zide BM, Jelks GW. Surgical anatomy of the orbit. Raven Press, 1985.
21. Flowers RS. Upper blepharoplasty by eyelid invagination: anchor blepharoplasty. Clin Plast Surg. 1993;20(2):193-207. doi:10.1016/S0094-1298(20)31211-6
22. Rohrich RJ, Pessa JE. The fat compartments of the face: anatomy and clinical implications for cosmetic surgery. Plast Reconstr Surg. 2007; 119(7):2219-2227. doi:10.1097/01.prs.0000265403.66886.54
23. Mendelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg. 2002;110(3):885-896. doi:10.1097/00006534-200209010-00026
24. Pusic AL, Klassen AF, Scott AM, Cano SJ. Development and psychometric evaluation of the FACE-Q satisfaction with appearance scale. Clin Plast Surg. 2013;40(2):249-260. doi:10.1016/j.cps.2012.12.001
25. Klassen AF, Cano SJ, Scott A, et al. Measuring patient-reported outcomes in facial aesthetic patients: development of the FACE-Q. Facial Plast Surg. 2010;26(4):303-309. doi:10.1055/s-0030-1262313
26. Anderson RL, Gordy DD. The tarsal strip procedure. Arch Ophthalmol. 1979;97(11):2192-2196. doi:10.1001/archopht.1979.01020020510021
27. Baylis HI, Long JA, Groth MJ. Transconjunctival lower eyelid blepharoplasty: technique and complications. Ophthalmology. 1989; 96(7):1027-1032. doi:10.1016/s0161-6420(89)32787-4
28. Hester TR, Codner MA, McCord CD. The centrofacial approach for correction of facial aging using the transblepharoplasty subperiosteal cheek lift. Aesthetic Surg J. 1996;16(1):51-58. doi:10.1016/S1090-820X (96)70015-8
29. Hamra ST. Arcus marginalis release and orbital fat preservation in midface rejuvenation. Plast Reconstr Surg. 1995;96(2):354-362. doi:10. 1097/00006534-199508000-00014
30. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi:10.1136/bmj.e3054
31. Seyednejad H, Imani M, Jamieson T, Seifalian AM. Topical haemostatic agents. Br J Surg. 2008;95(10):1197-1225. doi:10.1002/bjs.6357
32. Spotnitz WD, Burks S. Hemostats, sealants, and adhesives: components of the surgical toolbox. Transfusion. 2008;48(7):1502-1516. doi:10.1111/j. 1537-2995.2008.01703.x
33. American Society of Plastic Surgeons. 2023 Plastic Surgery Statistics Report. Available at: www.plasticsurgery.org/documents/News/Statistics/ 2023/plastic-surgery-statistics-full-report-2023.pdf
34. International Society of Aesthetic Plastic Surgery. ISAPS Global Survey Results 2022. Available at: www.isaps.org/medical-professionals/isaps-global-statistics/