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Does Brow Lift Add Risk to Blepharoplasty? Answers From a Multicenter Analysis of 6126 Patients Undergoing Aesthetic Eye Surgery

Wormer, Blair A. MD*; Rankin, Timothy M. MD, MS*; Kaoutzanis, Christodoulos MD*; Al Kassis, Salam MD*; Gupta, Varun MD, MPH*; Grotting, James C. MD; Higdon, Kent K. MD*

doi: 10.1097/SAP.0000000000001255
Aesthetic Surgery: PDF Only

Background Brow lift is frequently combined with blepharoplasty; however, the literature is lacking on their combined effect on complication rates.

Objectives This study aims to evaluate major complication rates after blepharoplasty and brow lift and to determine if complication rates increase when blepharoplasty and brow lift were performed simultaneously.

Methods A prospective cohort of patients who underwent cosmetic blepharoplasty, brow lift, or a combination of the 2 procedures between 2008 and 2013 was identified from the CosmetAssure Insurance database. The primary outcome was a postoperative major complication requiring emergency room evaluation, hospital admission, or reoperation within 30 days. Groups were compared with univariate analysis (significance, P < 0.05).

Results A total of 6126 patients underwent aesthetic eye surgery, of which, 4879 (79.6%) underwent blepharoplasty, 441 (7.2%) brow lift, and 806 (13.2%) a combination the 2 procedures. Patients who underwent a combined procedure were older than patients who underwent isolated blepharoplasty or brow lift (55.5 ± 9.4 vs 54.6 ± 11.1 vs 53.3 ± 12.0 years; P < 0.01). In males, blepharoplasty was the most commonly performed procedure, followed by a combined procedure and brow lift (17.6% vs 12.9% vs 10.7%; P < 0.01). There were similar rates of smokers between the 3 groups (5.7% vs 8.0% vs 6.6%; P = 0.06). Between combined procedures, blepharoplasty, and brow lift there, were similar rates of major complications (0.4% vs 0.4% vs 0.7%; P = 0.65) and hematoma (0.2% vs 0.2% vs 0.5%; P = 0.49), which was the most common complication.

Conclusions Aesthetic eye surgery has a very low overall major complication rate (0.4%). When brow lift is combined with blepharoplasty, it poses no additional risk of major complications compared with either procedure alone.

From the *Department of Plastic Surgery, Vanderbilt University, Nashville, TN; and †Department of Surgery, Division of Plastic Surgery, University of Alabama, Birmingham, AL.

Received August 16, 2017, and accepted for publication, after revision August 23, 2017.

Blair A. Wormer, Timothy M. Rankin, Christodoulos Kaoutzanis, Salam Al Kassis, Varun Gupta, James C. Grotting, and Kent K. Higdon have all met International Committee of Medical Journal Editors guidelines for authorship credit with substantial contribution, drafting, approval, and are accountable for all aspects of the work.

Conflicts of interest and sources of funding: Blair A. Wormer, Timothy M. Rankin, Christodoulos Kaoutzanis, Salam Al Kassis, Varun Gupta, and Kent K. Higdon have no financial interest in any of the products, devices, or drugs mentioned in this article. James C. Grotting is a founder and shareholder of CosmetAssure (Birmingham, Ala), an author for Quality Medical Publishing (St Louis, Mo) and Elsevier (New York, NY), and a shareholder of Keller Medical (Stuart, Fla) and Ideal Implant (Dallas, Tex).

The authors received no financial support for the research, authorship, and publication of this article.

Reprints: Blair A. Wormer, MD, Department of Plastic Surgery, Vanderbilt University, D-4207 Medical Center North, Nashville, TN 37232-2345. E-mail:

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