Modified Sub-Brow Blepharoplasty Reduces Early Postoperative Directional Wrinkles Without Compromising Surgical Outcomes: A Prospective Randomized Controlled Trial

Background: Sub-brow blepharoplasty has become the preferred surgical approach for moderate-to-severe upper eyelid aging. Over the years, numerous modifications and innovations have been introduced to achieve more natural, durable, and precise postoperative outcomes. Objective: We conducted a prospective randomized controlled study to demonstrate that our modified sub-brow blepharoplasty technique can achieve a more natural upper eyelid contour in the early postoperative period while maintaining surgical outcomes during the available 6 month follow-up. Methods: Between June 2024 and June 2025, 60 patients were enrolled and randomly assigned to either the experimental group (modified sub-brow blepharoplasty) or the control group (orbicularis oculi muscle flap crossover fixation blepharoplasty). In addition to preoperative baseline characteristics, postoperative outcomes were evaluated using both subjective and objective measures. Results: There were no significant differences between the two groups in sex distribution, mean age, or upper eyelid skin laxity grading at baseline. At 3 months postoperatively, the experimental group showed a significantly lower incidence of abnormal directional wrinkles in the upper eyelid, higher physician GAIS scores, and lower anxiety levels. At 6 months postoperatively, the early between-group differences were no longer observed, no significant differences were observed between the two groups in any subjective or objective outcome measures. Conclusion: In this study, the modified sub-brow blepharoplasty technique provided more natural short-term aesthetic results while maintaining comparable surgical outcomes during the available 6 month follow-up. Level of Evidence I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.