Eyelid edema reduction following blepharoplasty: a 3D imaging-based pilot study on the efficacy of Hilotherapy.

Background: Eyelid edema is a frequent and distressing early complication of upper blepharoplasty, yet optimal postoperative management remains unsettled. Conventional cryotherapy (e.g., ice packs, cooling masks) provides unstable temperatures and can cause adverse effects. Systemic anti-inflammatory drugs are not suitable for all patients. Hilotherapy provides constant, precisely controlled cooling and has reduced swelling in maxillofacial surgery. Its value in eyelid procedures is unknown. This study used three-dimensional (3D) stereophotography to objectively quantify periocular changes and evaluate whether Hilotherapy reduces early postoperative eyelid edema after upper blepharoplasty. Methods: Twenty-three patients with symmetrical bilateral dermatochalasis (46 eyes) undergoing upper eyelid blepharoplasty under local anesthesia were enrolled. Surgery was performed simultaneously on both eyelids by two experienced surgeons using an identical technique. Hilotherapy was applied to one randomly assigned eye, with the contralateral eye serving as an untreated control. Eyelid edema was assessed using 3D stereophotography at four time points: immediately after treatment (T0), 24 hours (T1), 2 weeks (T2), and 3 months (T3) postoperatively. Results: Of the 23 patients (9 males, 14 females; mean age 65 years), 16 (69.6%) showed reduced swelling with Hilotherapy at T0, 15 (65.2%) at T1, and 13 (56.5%) at T2. In the treatment group, males had significantly more eyelid swelling than females at T0 (1.216±0.655 vs. 0.665±0.667 cm2, P=0.023), but this difference was not significant at T1 (1.343±0.579 vs. 1.019±0.784 cm2, P=0.166) or T2 (0.474±0.573 vs. 0.354±0.342 cm2, P=0.801). Compared to controls, the swelling was significantly lower in the treated eyelids at T0 (0.880±0.715 vs. 1.129±0.915 cm2, P=0.026) and T1 (1.146±0.728 vs. 1.399±1.059 cm2, P=0.042), indicating that Hilotherapy effectively reduces early postoperative eyelid edema. Conclusions: Hilotherapy is a well-tolerated and effective method for reducing postoperative eyelid edema in the early days following upper eyelid blepharoplasty. It may enhance postoperative care not only in blepharoplasty but potentially in eyelid surgery overall.