Case Report: Upper Eyelid Blepharoplasty Following Repeated Botulinum Toxin Injections: A Case Report

Abstract Dermatochalasis of the upper eyelids is a frequent age-related condition that may impair vision and pose a major aesthetic concern. Although both surgical and nonsurgical treatments are available, improper or repeated administration of nonsurgical approaches, such as botulinum toxin (BT) injections, can lead to functional issues, including eyelid heaviness, ocular fatigue, and patient dissatisfaction. We report the case of a 45-year-old Syrian man with bilateral upper eyelid dermatochalasis who had received multiple periocular BT injections over two years. Despite initial improvement, he developed recurrent skin redundancy, ocular heaviness, fatigue, headaches, and aesthetic dissatisfaction. Clinical examination revealed bilateral eyelid skin redundancy and superior visual field restriction with preserved levator function. Bilateral upper eyelid blepharoplasty was performed, involving careful excision of redundant skin, removal of excessive preaponeurotic fat likely accentuated by prior BT treatment and partial excision of the orbicularis oculi muscle, while preserving the levator apparatus and orbital septum integrity. The procedure was completed without complications. Postoperatively, the patient experienced complete resolution of eyelid heaviness and subjective improvement in the visual field, as well as a more defined eyelid contour and improved symmetry. Patient satisfaction, measured using the Blepharoplasty Outcomes Evaluation (BOE) questionnaire, increased from 25% preoperatively to 96.8% at three and six months postoperatively. This case demonstrates that upper eyelid blepharoplasty remains the gold standard for managing dermatochalasis, particularly when nonsurgical interventions have failed or produced functional complications. The procedure can successfully restore eyelid function, improve visual performance, and achieve high aesthetic satisfaction, highlighting the importance of proper patient selection and timely surgical intervention in the management of upper eyelid aging.