INTRODUCTION
Aging is a biological process that results in several anatomical and functional
changes in the human body. In this context, the eye region is essential to
guarantee facial harmony, in addition to being an important means of social
communication, constituting the most important aesthetic-functional component
of
the face, and any changes in this region can lead to compromised such
functions1.
In this sense, one of the most frequent clinical manifestations derived from the
natural aging process is eyelid ptosis2, which mainly affects the upper eyelid and may have
other etiologies in addition to aging, such as neurogenic, myogenic, traumatic,
or even congenital factors3. As
a consequence, eyelid ptosis brings to the patient a reduction in campimetry
and
visual quality, an increase in the incidence of entropion (a condition that
facilitates contact between the eyelashes and the ocular conjunctiva,
predisposing to infections), and a decline in self-esteem, contributing
significantly to the reduction of the quality of life1.
In this context, blepharoplasty arises, a surgical procedure that aims to correct
any functional or aesthetic abnormality existing in the eyelids, mostly
performed by plastic surgeons and ophthalmologists1. Due to its notorious importance, the Unified
Health System (Sistema Único de Salud SUS) guarantees citizens
the right to undergo reconstructive plastic surgery, especially when there is
partial or total functional impairment and there are no treatment alternatives
other than surgery. In this way, patients are guaranteed blepharoplasty surgery
through the SUS when the functional declines described above are
proven4.
From this perspective, this scoping review was carried out, to elucidate and
substantiate what the coverage of care for patients in need of blepharoplasty
in
the SUS really is, as well as the scope of its impact on patients’ quality of
life.
OBJECTIVE
Therefore, the main objective of this scoping review was to systematically map
the available research on the proposed topic, in addition to delimiting the
remaining gaps in the study of the area. To this end, the following research
questions were formulated: What is known about the impact of upper
blepharoplasty on quality of life? What is its scope in the single health
system?
METHOD
This study is a scoping review guided by the references and principles proposed
by the Joanna Briggs Institute (JBI) and Preferred Reporting Items for
Systematic Review and MetaAnalyses extension for Scoping Review (PRISMA-
ScR)5,6, aiming to search for information available, as
well as the identification of remaining gaps in the subject covered by following
the steps: formulation of objectives and research questions (“What is known in
the literature about the impact of blepharoplasty on quality of life and its
scope in the SUS? ”; structuring the research question using the acronym PCC
-
Population: individuals undergoing blepharoplasty / Concept: quality of life
/
Context: blepharoplasty surgery, SUS); elaboration of exclusion and inclusion
criteria; development of the search strategy; search and selection of studies;
data mapping and synthesis of results.
Eligibility Criteria
To select the studies, the following criteria were used: studies published
from 2017 to 2022, that addressed quality of life, functionality, and
patient satisfaction after upper blepharoplasty, performed as the first
intervention, in English, Portuguese, and Spanish, with the application of
the filter “in the last 5 years”. Quantitative, qualitative, and mixed
studies were included, aiming for a broad understanding of the topic.
Information sources
The bibliographic survey took place from March to June 2022, based on
searches in the electronic databases Medline, VHL, Periódicos Capes, SciELO,
and LILACS. In addition to searching journals, data were collected from the
official websites of the Ministry of Health and the Sociedade
Brasileira de Cirurgia Plástica.
The results obtained were exported to EndNote to exclude repeated articles.
The search strategy used was through the descriptors present in MeSH
(Medical Subject Headings) and DeCS (Health Sciences Descriptors):
“Blepharoplasty”, “Quality of Life”, “Visual Field Tests”, “Patient
Satisfaction” and “ Health Unic System”.
These descriptors were combined using the Boolean operators OR and AND, which
were used in the databases as expressed in Chart 1.
Chart 1 - Search strategy used.
| Databases/
Libraries/ Search Engines/ Grey Literature
|
Search
Strategies
|
| PubMed, VHL,
Journals Capes, LILACS, SciELO, Cochrane.
|
((“Blepharoplasty” OR “Eyelid surgery”)) AND ((Quality of
life))
((“Blepharoplasty” OR “Eyelid surgery”)) AND
((Visual field test))
((“Blepharoplasty” OR “Eyelid
surgery”)) AND ((Patient satisfaction OR
satisfaction))
((“Blepharoplasty” OR “Eyelid
surgery”)) AND ((Patient satisfaction)) AND ((Quality of
life)) AND ((Visual field test))
|
Chart 1 - Search strategy used.
To increase the consistency of the research, all articles found in the
databases described were selected together by the researchers, following the
order of title, abstracts, and, finally, full text, so that, in the end,
through discussion between the evaluators, only those studies that
contributed to answering the research questions were classified by
consensus.
The first search, selecting articles based on the title, totaled 323 articles
chosen. After duplicates were removed (130), 193 citations remained. After
this stage, the summary of the articles in question was read, leaving 113
studies. Finally, after reading the full text, and taking into account the
eligibility criteria, we had 19 articles eligible for this scoping review.
Of the 94 excluded studies, 81 did not discuss or speak very superficially
about the impact of blepharoplasty on patients’ quality of life and 13 dealt
only with lower blepharoplasty. Data is expressed in Figure 1.
Figure 1 - Flowchart of the study selection process.
Figure 1 - Flowchart of the study selection process.
RESULTS
The title, author, year, journal, objectives, study design, methods, and results
of the studies concerning the research questions are presented in Chart 2.
Chart 2 - Description of included studies.
| Title |
Authors, Year,
and Journal
|
Objectives |
Design |
Number of
participants and age
|
Methods |
Result |
| The Effect of
Blepharoplasty on Our Patient’s Quality of Life, Emotional
Stability, and Self-Esteem7 |
Papadoulos et
al., 2019
The Journal of Craniofacial Surgery
|
Determine
whether blepharoplasty affects the quality of life,
satisfaction, emotional stability, and self-esteem
|
Retrospective
study with patients who underwent transdermal blepharoplasty
between 1995 and 2008
|
46 patients
(age 38-75 years)
|
Application of
a self-developed questionnaire for blepharoplasty, in addition
to the Statistically significant increased values in quality of
life (FLZM), Freiburg Personality Inventory (FPI-RL), and
Rosenberg Self-Esteem (RSES).
|
Improved
quality of life in the aspects: of work, mobility, and
independence. Increased self-esteem
|
Association on of Upper Eyelid Ptosis Repair and
Blepharoplasty
With Headache-Related Quality of
Life8 |
Bahceci Simsek, 2017
JAMA Facial Plast Surgery
|
To evaluate changes in headache-related quality
of life in patients undergoing upper blepharoplasty
|
Prospective cohort study |
108 patients undergoing blepharoplasty and 44
patients undergoing ptosis correction (age 45-49 years)
|
Application of the Headache Impact Test-6 (HIT)
questionnaire preand postoperatively for patients with tension
headache.
|
Increase in Headache Impact Test-6 (HIT) score in
the two groups studied (ptosis repair and upper
blepharoplasty)
|
| Upper eyelid
blepharoplasty using Plasma exeresis: Evaluation of outcomes,
satisfaction and symptoms after procedure9 |
Ferreira et
al., 2021
Journal of Cosmetic Dermatology
|
To evaluate
patient satisfaction and symptoms after upper blepharoplasty
using plasma technology
|
Observational
study of patients who underwent upper blepharoplasty using
plasma to treat dermatitis
|
16 patients
(average age 50.5 years)
|
Assessment of
quality of life, symptoms, and satisfaction using two
questionnaires on day 7 and 30 after the procedure
|
High level of
satisfaction, but low impact on daily quality of life
|
| Functional benefits and patient satisfaction with
upper blepharoplasty - evaluated by objective and subjective
outcome measures10 |
Jacobsen et al., 2017
Acta Ophthalmology
|
Investigate functional outcomes and patient
satisfaction in upper blepharoplasty
|
Observational cohort study |
45 patients (mean age 56.9 years) |
Preand postoperative analysis of the patient's
visual capacity, together with a questionnaire to assess the
functional and psychosocial impact of the eyelid
|
Increase in the superior visual field by 31.3% on
the right side and 28.3% on the left side. All patients were
satisfied with the postoperative result and would undergo
surgery again.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Measuring
satisfaction with appearance: Validation of the FACE-Q scales
(ferramenta de resultados relatados pelo paciente (PRO) composta
por várias escalas e listas de verificação com funcionamento
independente, projetadas para medir os resultados) for
double-eyelid blepharoplasty with minor incision in young
Asiansretrospective study of 200 cases11 |
Chen et al.,
2017
Journal of Plastic, Reconstructive & Aestethic
Surgery
|
Use a
validated FACE-Q questionnaire (a patient-reported outcomes
(PRO) tool comprised of multiple independently functioning
scales and checklists designed to measure outcomes) to assess
patient-reported satisfaction after small-incision double
blepharoplasty
|
Retrospective
study with patients who underwent double blepharoplasty between
2012 and 2014
|
200 patients
(age 21-30 years)
|
Administration
of the FACE-Q questionnaire (a patient-reported outcomes (PRO)
tool comprised of several independently functioning scales and
checklists designed to measure outcomes) anonymously via
email
|
High level of
satisfaction with overall eye appearance and increased quality
of life, including confidence and well-being
|
| Functional outcomes of upper eyelid blepharoplasty:
A systematic review12 |
Hollander et al., 2019
Journal of Plastic, Reconstructive & Aestethic
Surgery
|
Review the literature to evaluate the objective
and subjective functional benefits of upper blepharoplasty
|
Revisão sistemática |
3525 estudos |
Busca sistemática em 4 bases de dados (Pubmed,
Embase, Cinahl e Cochrane)
|
28 estudos foram incluídos e mostraram aumento do
campo de visão, aumento da qualidade de vida por diminuição da
cefaleia e melhora da visão e diminuição da sensibilidade das
pálpebras. Resultados para altura da sobrancelha, astigmatismo,
sensibilidade ao contraste e cinemática da pálpebra não foram
consistentes.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Investigation of
Goldmann perimetry in evaluation of patients for upper eyelid
blepharoplasty13 |
Pemberton et
al., 2018
Orbit
|
To determine
whether the preoperative Goldman Visual Test (GVT) tested in
patients with functional dermatochalasis describes the
postoperative superior visual field outcome
|
Prospective
cohort study
|
23 patients
(mean age 67 years)
|
Obtaining the
Goldman Visual Test (GVT) pre-operatively with the eyelids in
the natural position and post-operatively and subsequent
analysis to determine whether the pre-operative test accurately
predicts visual field improvement
|
Preoperative
testing underestimated postoperative outcome by an average of
35%, therefore, postoperative improvement in the visual field is
typically greater after blepharoplasty than the Goldman Visual
Test (GVT) predicts.
|
| Objective quantification of the impact of
blepharoplasty on the superior visual field14 |
Kim et al., 2022
Archives of Plastic Surgery
|
To analyze the visual field before and after
surgery and investigate whether visual field measurements can be
applied as an adequate predictor of surgical results
|
Prospective study |
9 patients (mean age 59.66 years) |
Nine patients with pseudoptosis who underwent
blepharoplasty participated. Visual fields were analyzed
preoperatively and 3 months postoperatively with the
Goldmann
kinetic perimetry test
|
Blepharoplasty had an average beneficial effect
of 4.99 times on the superior field of vision. There was a
strong correlation between the preoperative superior visual
field and the surgical outcome.
|
| Assessment of
Patient Satisfaction With Appearance, Psychological Well-being,
and Aging Appraisal After Upper Blepharoplasty: A Multicenter
Prospective Cohort Study15 |
Domela
Nieuwenhuis et al., 2022
Aesthetic Surgery Journal
|
To evaluate
patient-reported satisfaction with facial appearance,
psychological well-being, and assessment of aging after upper
blepharoplasty with validated questionnaires
|
Prospective
cohort study
|
2134 elderly
patients
|
Upper
blepharoplasty patients from 8 outpatient clinics were included.
Patient-reported satisfaction was assessed with the FACE-Q at
admission and 6 and 12 months postoperatively.
|
Large
improvements in FACE-Q scores between admission and 6 months
postoperatively were observed for satisfaction with appearance,
psychological well-being, and assessment of aging. Satisfaction
with treatment results was strongly correlated with satisfaction
with appearance, but not with assessment of aging.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Patient-reported outcome measurement in upper
blepharoplasty: How to measure what the patient sees 16 |
Herruer et al., 2018
Journal of Plastic, Reconstructive & Aestethic
Surgery
|
Research the outcome of blepharoplasty in terms
of satisfaction and quality of life, as well as determine a
recommendation on which assessment tools should be used
|
Prospective study |
56 patients (36 completed all questionnaires,
(mean age 55 years)
|
Patients undergoing blepharoplasty completed
Blepharoplasty outcome evaluation (BOE) and Derriford appearance
scale 59 (DAS59) questionnaires preoperatively and 3-6 months
postoperatively. Visual analog scales (VAS) were also used
preand postoperatively and the Glasgow Benefits Inventory (GBI)
was used postoperatively.
|
Both satisfaction with the eyes and self-esteem
improved significantly. Patients reported significant benefits
after the procedure.
|
| Effects of Upper
Eyelid Blepharoplasty on Contrast Sensitivity in Dermatochalasis
Patients1
7 |
Nalci et al., 2020
Turkish Journal of Ophthalmology
|
To evaluate
the impact of upper eyelid blepharoplasty on contrast
sensitivity in patients with dermatochalasis
|
Prospective
study
|
34 patients
(mean age 59.66 years)
|
Preoperatively
and postoperatively, best-corrected visual acuity,
ophthalmological examination, eyelid examination, eyelash
ptosis, contrast sensitivity, keratometric parameters, and
corneal aberrations were evaluated in 34 eyes of patients
undergoing upper blepharoplasty for dermatochalasis among the
years 2014 and 2018
|
Contrast
sensitivity increases significantly after upper blepharoplasty,
especially at higher spatial frequencies. Blepharoplasty may
have additional functional indications for elderly patients with
dermatochalasis in terms of improving functions such as
performing daily tasks and reading.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| A practical technique combining orbicularis oculi
muscle resection-based epicanthoplasty and orbicularis-tarsus
fixation double-eyelid plasty for cosmetic
blepharoplasty18 |
Sun et al., 2019
Journal of Plastic, Reconstructive & Aestethic
Surgery
|
To describe a technique that combines
epicanthoplasty based on resection of the orbicularis oculi
muscle and double eyelid plasty with orbicularis tarsus fixation
for cosmetic blepharoplasty and report the surgical results in a
large number of Chinese patients.
|
Prospective study |
475 patients with an average age of 26 years |
From January 2015 to February 2019, 475 patients
underwent double eyelid blepharoplasty associated with
epicanthoplasty using this technique. The follow-up period
ranged from 2 to 38 months, with an average of 16 months
|
97% of patients were satisfied with the surgical
results, presenting well-defined eyelid folds and a naturally
improved contour of the inner corner, with no evident scar.
Photographic analysis showed a significant improvement in the
proportion of the palpebral fissure postoperatively.
|
| Surgical outcome
and patient satisfaction after Z-epicanthoplasty and
blepharoplasty19 |
Zhao et al.,
2019
International Journal of Ophthalmology
|
To evaluate
the surgical outcomes of the modified Z-epicanthoplasty with
blepharoplasty that we previously reported from the patient's
perspective using patient-reported outcome measures (PROMs) and
patient satisfaction scores.
|
Retrospective
study
|
180 patients
(average age 24 years)
|
180 patients
who underwent surgery between January 2013 and June 2016 were
randomly selected. Standardized patient satisfaction forms and
questionnaires using validated patient-reported outcome measures
(PROMs) were sent to patients for completion.
|
Most patients
reported good or excellent results on analysis of
patient-reported outcome measures (PROMs). In questions relating
to function and appearance, 80.3% reported satisfaction with
both domains. Most patients reported a high or very high
satisfaction rate producing an average score of 104 out of 120
for the patient satisfaction assessment
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Factors Influencing Patient Satisfaction with Upper
Blepharoplasty in Elderly Patients20 |
Kim et al., 2021
Plastic and Reconstructive Surgery-Global Open
|
Research which factors influence elderly patient
satisfaction in upper blepharoplasty
|
Prospective study |
57 patients (over 65 years of age) |
Patients undergoing upper blepharoplasty between
April 2018 and March 2019 responded to a pre-operative
questionnaire and after 6 months, a satisfaction survey was
carried out.
|
Significant verification of regression
coefficients showed that functional improvement and cognitive
degree of postoperative precautions had a significant effect on
patient satisfaction, while aesthetic results and surgical
outcome expectations were not correlated with patient
satisfaction.
|
| Qualidade de
vida e autoestima em idosas submetidas e não submetidas à
cirurgia estética21 |
Spadoni-Pacheco e Carvalho, 2018
Revista Brasileira de Cirurgia Plástica
|
To evaluate
the importance of aesthetic surgery (CE) for the elderly, and
whether there is a difference in quality of life and self-esteem
between elderly women who have and have not undergone cosmetic
surgery.
|
Case-control
study
|
25 elderly
women who underwent cosmetic surgery (EC) and 25 elderly women
who did not undergo CE (average age of 67.26 years).
|
Case group
formed by 25 elderly women who underwent aesthetic surgery (CE)
and the control group of 25 elderly women who did not undergo
aesthetic surgery (CE). The instruments applied were:
Minimental, quality of life questionnaire (WHOQOL-BREF),
Rosenberg self-esteem scale, and a questionnaire designed to
research sociodemographic data, motivation, and satisfaction
with aesthetic surgery (CE).
|
The most chosen
reasons for surgery were physical discomfort, the desire to
improve quality of life (QoL), and dissatisfaction with
self-image. No elderly women were found with low self-esteem and
the level of satisfaction was high when related to their own
life or social life. There was no difference in quality of life
(QOL) and self-esteem between the two groups analyzed.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Assessment of self-esteem and psychological aspects
in patients undergoing upper blepharoplasty22 |
Gracitelli et al., 2017
Revista Brasileira de Oftalmologia
|
To evaluate the results of self-esteem and
quality of life in patients undergoing upper
blepharoplasty.
|
Cross-sectional study |
49 individuals diagnosed with
dermatochalasis.
|
The self-esteem and quality of life of patients
undergoing upper blepharoplasty were compared with volunteers of
the same age. Preoperative assessment included ophthalmological
examinations and two questionnaires: the Rosenberg Self-esteem
Scale (RSES) and the World Health Organization quality of life
assessment (WHOQOL-BREF).
|
Individuals undergoing upper blepharoplasty had
worse self-esteem based on the Rosenberg Self-Esteem Scale
(RSES).
Regarding the quality of life, assessed by the
World Health Organization the quality of life assessment
(WHOQOL-BREF), significant differences were evident between the
groups in the psychological aspects subscale.
|
| The Bleph and
the Brain: The Effect of Upper Eyelid Surgery on Chronic
Headaches2
3 |
Mokhtarzadeh
et al., 2017
Ophthalmic Plastic & Reconstructive Surgery
|
Determine the
effect of upper eyelid surgery on headache symptoms
|
Case-control
study
|
47 patients
(age 58.7 to 60.7 years)
|
Case and
control groups completed a preand post-operative Headache Impact
Test-6 quality of life questionnaire. The study was carried out
over a period of 2 years.
Neither patients nor study
investigators were masked.
|
Postoperative
scores were better in the case group compared to the control
group. All questions on the Headache Impact Test-6 improved
significantly in the case arm compared to the control.
Subjectively, 25 of 28 study patients and 4 of 19 control
patients noted some improvement in symptoms after surgery.
|
| Title |
Authors,
Year, and Journal |
Objectives |
Design |
Number
of participants and age |
Methods |
Result |
| Resultados funcionales de la blefaroplastia
superior2 |
Hernández Sánchez et al., 2021
Revista Cubana de Oftalmologia
|
Describe the functional results of upper
blepharoplasty
|
Prospective longitudinal study |
99 patients (age 50-62 years) |
A prospective longitudinal descriptive study was
carried out on patients diagnosed with upper eyelid
dermatochalasis, some associated with eyelid and eyebrow ptosis
from February 2019 to January 2020.
|
In 98% of the intervention cases, total
correction of dermatochalasis of the upper eyelid was achieved,
ptosis correction in 86%, and eyebrow correction in
88%.
There were no complications in 94% of the operated
eyelids. The most frequent complication was bleeding, with
2.5%.
|
| Influence of
upper blepharoplasty on intraocular lens calculation2
4 |
Vola et al., 2021
Arquivo Brasileiro de Oftalmologia
|
Determine the
effect of upper blepharoplasty on corneal topography and
intraocular lens power calculation using Galilei and IOLMaster
(Holladay formula).
|
Case series
study
|
30 patients
(age 47.7 - 74.4 years).
|
Patients
undergoing upper blepharoplasty underwent imaging sessions with
Galilei and IOLMaster (Holladay's formula) preoperatively and at
1 and 6 months postoperatively. Axial length determination and
lens power calculation were performed using only IOLMaster
(Holladay formula). Paired t-tests and vector analysis were used
for statistical analysis.
|
Vector analysis
showed that 6 months after surgery, blepharoplasty induced on
average 0.39D and 0.31D of corneal astigmatism, measured with
Galilei and IOLMaster (Holladay's formula). IOLMaster
measurements (Holladay's formula) showed that mean corneal
curvature, steepest corneal curvature, and corneal astigmatism
were greatest 6 months after surgery. They also showed that
intraocular lens power was significantly lower 6 months after
surgery.
|
Chart 2 - Description of included studies.
Of the selected studies, only seven of them7-10,12,21,22 cited or
directly evaluated the criterion of improvement in quality of life; of these,
five7,8,11,12,22 found a statistically significant increase in quality
of life after blepharoplasty, one found no significant differences21 and another found a low impact
on quality of life on the seventh day after surgery9. The age of individuals participating in these
studies varied, with one article without specification12, four (57%) with patients at least 50 years
old9,10,21,22, one between 45 and 49 years
old8 and another
covering patients from 38 to 75 years old.
Six studies analyzed the functional results of upper blepharoplasty2,10,13,14,17,24, a criterion
that was considered by the present review as a possible contributing factor to
the improvement in quality of life. Of these studies, three found a significant
increase in the superior field of vision10,13,14, one showed a significant
increase in contrast sensitivity17 after surgery and, together with another study24, demonstrated excellent levels
of correction of dermatochalasis. Furthermore, induction of corneal astigmatism
and decreased power of the intraocular lens were also found after
blepharoplasty25. Most
research was carried out on patients over 55 years old10,13,14,17,25 and only one
had an age ranging between 47.7 and 74.4 years24. In all studies, the majority of patients were
female.
Finally, six studies11,15,16,18,20,23 evaluated subjective issues that may be linked to
improved quality of life, such as patient satisfaction15,16,18,20, headache improvement23, psychological well-being15 and self-esteem16. They all found significant
improvements in the respective criteria analyzed, through the application of
questionnaires to participating patients.
From the results demonstrated here, it was clear that, with a few
exceptions9,21,24, blepharoplasty has a positive and significant impact
on the lives of patients undergoing surgery, whether due to functional or
well-being criteria. Benefits include high satisfaction, improved self-esteem,
increased field of vision, safety, and well-being.
Considering all the benefits, blepharoplasty surgery is provided by the SUS and
is included in the Table of Procedures, Medications, Orthoses and Prostheses,
and Special Materials of the Unified Health System (SIGTAP)25. The amount spent by the SUS
to carry out this procedure was changed by ordinance no. 3,03726, of November 14, 2017, to
449.44 reais. Blepharoplasty may be recommended by a general practitioner or
ophthalmologist in the following conditions: (1) dermatochalasis (excess skin
and sagging in the upper eyelid fold) with obstruction of the visual axis, (2)
lagophthalmos (palpebral malocclusion), (3) alteration the position of the
eyelids, (4) post-trauma eyelid deformities or burn sequelae4.
However, the procedure is only covered by the SUS in hospitals where there is a
Plastic Surgery residency27.
According to data from the Sociedade Brasileira de Cirurgia Plástica
(SBCP), in Brazil, there are 88 accredited medical residency
services, several of which are located in the same city and 13 (50%) of the 26
Brazilian states are not covered by any accredited service. , demonstrating the
scarcity and difficulty in accessing this resource for the population.
No data was found on the SUS waiting list, as well as the number of
blepharoplasties performed per year, making it impossible to conclude the
reality of the expected coverage. The only data found on the coverage of plastic
surgeries by the SUS was provided by the SBCP Census of 201628, which demonstrated that, of
the total number of plastic surgeries performed that year, 16.30% were performed
by the SUS, however, there is no specification of how much this percentage
represents the blepharoplasty itself.
On the other hand, some actions, mainly by the SBCP, sought to make up for the
deficit in the care of these patients on the waiting list, in the form of
blepharoplasty joint efforts carried out in some Brazilian cities29. These actions, for the most
part, take place in partnership with SUS hospitals and bring together medical
teams that mobilize in a short period to serve as many patients as possible.
Despite the lack of data on the number of surgeries performed by the SUS, the
need to organize actions like these already denotes the existence of a gap in
necessary care in the area.
Furthermore, in the databases searched, no study was found on the inclusion of
blepharoplasty in the SUS, only on other reconstructive plastic surgeries, such
as skin and breast tumors.
This scoping review has some limitations. The main one was the lack of
publications dealing with the topic, in addition to extremely scarce and limited
data regarding the coverage of blepharoplasty by the SUS, mainly in the
scientific literature, with no scientific study on this being found. Therefore,
it was not possible to have clarity on the Brazilian scenario in terms of the
real demand of the population, the waiting list, and the surgery itself. Another
limitation of this review is that no randomized clinical trial was found
regarding the effects of blepharoplasty on any of the outcomes mentioned. All
primary studies included in this review were observational, being cohorts,
case-control, and case series. Therefore, there is a great need to develop
well-conducted randomized clinical trials that evaluate the effectiveness of
upper blepharoplasty on relevant patient outcomes.
CONCLUSION
In the selected studies that sought to understand the influence of blepharoplasty
on patients’ quality of life, different ways of clarifying this relationship
were found. The first was direct, with a specific focus on analyzing
improvements in quality of life, through pre-defined criteria. The second was
indirectly, researching criteria that, by inference, increase quality of life,
such as personal satisfaction, self-esteem, improvement in headaches, and other
functional criteria.
In both research focuses, the vast majority of them demonstrated an effective
increase in the quality of life factor in patients undergoing surgery. In
addition to the improvement in quality of life, there were reports of functional
improvements and subjective criteria linked to quality of life, such as
self-esteem and satisfaction. Thus, 73% of studies found some type of positive
influence from blepharoplasty. However, the number of studies that have analyzed
this relationship in depth is still scarce.
Regarding the inclusion of blepharoplasty in the SUS, the data found was
insufficient to have a good overview, and no study was found on the subject,
demonstrating a gap in scientific knowledge aimed at this purpose.
In this sense, there seems to be a neglect of this topic in public health, with
the practical consequence of having a negative effect on the quality of life
of
many patients who have criteria and the right to undergo blepharoplasty, but
who, unfortunately, are not met. Furthermore, the lack of research makes it
difficult to truly understand the importance and impact of this surgery.
It is therefore encouraged to carry out studies, focused on deepening the
relationship between blepharoplasty and quality of life, but mainly evaluating
the impact of coverage of this procedure within the Unified Health System.
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1. Pontifícia Universidade Católica de Minas
Gerais, Poços de Caldas, MG, Brazil
Corresponding author: Lucas Freire Guerra Boldrin
Rua Assis Figueiredo 515, apto 107, Centro, Poços de Caldas, MG, Brazil, Zip
Code: 37701-000, E-mail: guerralucas1807@gmail.com
Article received: August 13, 2023.
Article accepted: February 04, 2024.
Conflicts of interest: none.
