Evaluation of periocular scars after blepharoplasty and external dacryocystorhinostomy according to Manchester and modified Vancouver scar score.

Abstract

Objective: The aim of this study was to evaluate and compare the scars of two groups of patients who underwent different periorbital surgical procedures, blepharoplasty and external dacryocystorhinostomy (DCR), using established scar scales. We aimed to compare the cosmetic outcomes of incisions parallel and perpendicular to the skin lines and to evaluate the relationship between patient satisfaction, skin aging, skin phototypes, and scar scores.

Methods: This cross-sectional study included 55 patients who underwent upper eyelid blepharoplasty and 50 patients who underwent external DCR. Patients' postoperative scars were assessed between 12 and 36 months after surgery using the fitzpatrick skin type scoring (Type I white skin-Type VI dark brown/black skin), Modified Fitzpatrick Wrinkle Scale (MFWS) (Class 0 no wrinkle-Class 3 deep wrinkle), modified vancouver scar scale (MVSS) (pigmentation, vascularity, pliability, height) and the Manchester Scar Scale (MSS) (visual analog scale, color, matte/glossy, contour, distortion, texture) by an ophthalmologist and a dermatologist. The assessment was blinded. Finally, all participants answered a patient satisfaction scale consisting of three questions [(1) Can you see the wound (2) Is the scar important to you? (3) Would you undergo the same operation again regarding the scar?].

Results: Both MSS and MVSS scores were higher in the blepharoplasty group than in the external DCR group (p = 0.041, p = 0.029). As patient dissatisfaction increased, a significant increase in both MSS and MVSS scoreswas observed (p = 0.001, r = 0.308; p = 0.025, r = 0.219).

Conclusion: According to the patient satisfaction scale, blepharoplasty and external DCR were not significantly different, but external DCR resulted in less scarring than blepharoplasty according to MSS and MVSS (performed by a dermatologist and an ophthalmologist). We found that the scar score was influenced by the amount of wrinkles, but not by age or skin color. To our knowledge, this is the first study to compare both the MSS and MVSS scar scores with patient satisfaction after periocular surgery. Finally, both the MSS and MVSS scar scores provide an objective and useful method of assessing postoperative scarring and can therefore help surgical teams optimize their procedure and achieve a better outcome.