Are large language models consistent with the ASPS and AAPS guidelines? A comparison of AI chatbot recommendations and plastic surgery clinical guidance.

To assess the clinical outcomes and patient satisfaction 6 months after undergoing lower eyelid surgery using the suborbicularis oculi fat (SOOF) lift combined with fat pad transposition in patients aged 40 to 65 in Vietnam. This longitudinal interventional study was conducted on 27 patients who underwent SOOF lift combined with fat pad transposition at Vietnam National Eye Hospital, between October 2023 and March 2025. All cases were evaluated based on various factors, including age, gender, Goldberg scale, eye bag height (AB), the orbital rim angle, and Face-Q score before surgery and at 1 week, 1, 3, and 6 months postoperatively. The study included 27 patients with a mean age of 57.41 years, with 8 males and 19 females. Half of the patients also underwent upper eyelid surgery or brow lift in conjunction with the lower eyelid procedure. At the follow-up visits, all indicators of lower eyelid aging showed significant improvement, with results stabilizing between the 3-month and 6-month assessments. No major complications were reported. All patients expressed satisfaction with the surgical outcomes and estimated an average of 7 years younger than their actual age. The combination of SOOF lift and fat pad transposition in lower blepharoplasty offers a safe, effective, and long-lasting solution for addressing age-related changes in the lower eyelid region, leading to significant improvements in both aesthetic outcomes and patient satisfaction.

To compare the incidence of surgical site infections (SSI) following routine ophthalmic soft tissue surgeries in dogs receiving (AB) and not receiving (noAB) postoperative antibiotics. Clinical records of dogs that underwent enucleations, wedge resections, medial canthoplasties, and simple and complicated eyelid surgeries with at least 3 months follow-up were retrospectively reviewed. SSI were recorded when increased mucoid or purulent discharge was present postoperatively or wound dehiscence occurred. SSI were graded based on Clavien-Dindo's classification according to the therapeutic intervention required. A total of 231 dogs (AB = 108; noAB = 123) met the inclusion criteria for enucleations, 135 for wedge resections (AB = 62; noAB = 73), 31 for medial canthoplasties (AB = 15; noAB = 16), and 30 and 22 for simple (AB = 13; noAB = 17) and complicated (AB = 7; noAB = 15) eyelid surgeries, respectively. There was no significant difference in SSI rates between patients receiving topical or systemic postoperative antibiotics and those not receiving antibiotics. Variables associated with an increased risk of SSI included a brachycephalic phenotype in eyelid wedge resections and high body weight in simple and complicated eyelid surgeries. The SSI were classified as grade 1 in 6/32 (18.8%) patients and grade 2 in 20/32 (62.5%) patients. 4/32 (12.5%) patients with SSIs were classified as grade 3b and required surgical intervention. Postoperative systemic and topical antibiotics did not reduce SSI. The high incidence of SSI in medial canthoplasties and eyelid surgeries independent of postoperative antibiotic use highlights the need to reconsider pre-, peri- and postoperative protocols, including suture material selection and the implementation of wound cleaning routines.

To identify predictors of ocular complications and to investigate treatment approaches in patients with facial paralysis (FP) in Taiwan. Retrospective database study. Patients with FP in the Chang Gung Research Database (2001-2022) were enrolled. Primary outcomes were ocular complications, including eyelid malposition (eg, lagophthalmos, ectropion) and ocular surface diseases (eg, recurrent corneal erosion, corneal ulcer). Predictors (demographics, comorbidities, and causes of FP) were assessed by use of the Cox proportional hazards model. A hazard ratio (HR) ≥1.50 or ≤0.67 was predefined as clinically significant. Secondary outcomes included treatment approaches. Among 36,382 patients with FP, 55.38% were diagnosed with Bell palsy; 4.95%, with new stroke; and 4.55%, with head and neck injury. Ocular complications developed in 9.22% of the patients. Factors associated with increased hazard included underlying chronic obstructive pulmonary disease (HR: 1.64; 95% CI: 1.46-1.85) and causes of FP due to head and neck injury (HR: 2.47; 95% CI: 2.19-2.79), brain tumors (HR: 2.26; 95% CI: 1.93-2.66), birth trauma (HR: 1.70; 95% CI: 1.42-2.04), surgery for brain tumors (HR: 1.59; 95% CI: 1.11-2.28), and head and neck tumors (HR: 1.56; 95% CI: 1.29-1.89). Among all the causes of FP, Bell palsy was associated with the lowest hazard of ocular complications (HR: 0.81; 95% CI: 0.75-0.88). Surgeries were required in 10.35% of patients, including 1.34% for dynamic reconstruction (muscle transfer and/or neurotization), 0.98% for static eyelid surgeries (eg, eyelid malposition correction, temporary tarsorrhaphy), and 0.05% for corneal transplant. Bell palsy, the predominant cause of FP, showed the lowest hazard of ocular complications, whilst head and neck injuries showed the highest hazard.

We report a patient who developed ocular penetration with a traumatic cataract following double-eyelid blepharoplasty. A 19-year-old woman experienced immediate visual loss in her left eye after surgery. A slit-lamp examination revealed puncture wounds involving the cornea, iris, and full-thickness lens capsule, suggesting a linear penetrating injury. Due to the development of a traumatic cataract, the patient underwent phacoemulsification with intraocular lens implantation combined with pars plana vitrectomy. Postoperatively, visual acuity improved significantly without retinal complications. This case emphasizes the potential for severe intraocular injury during eyelid surgery and highlights the need for greater attention to cautious anesthetic techniques.

To describe a novel, low-cost, and high-quality intraoperative video recording setup for oculoplastic surgery using a magnetic neck-mounted smartphone holder and iPhone with the Final Cut Camera app. A magnetic neck mount (Tianzhu Insta 360, China) and an iPhone 16 Pro Max were adapted for surgical recording by securing the holder around the binocular base of the operating microscope. The magnetically attached phone provided a stable and adjustable platform, allowing intraoperative view adjustments via the microscope's handles or foot pedal without compromising sterility. The Final Cut Camera app enabled 4K video capture with manual control of focus, exposure, and white balance. Its Live Multicam feature allowed simultaneous multi-angle recording and real-time monitoring via a compatible iPad, enabling an assistant to control framing and clarity intraoperatively. A multi-port adapter was used to support continuous power and external memory. Over six months, more than 50 oculoplastic procedures, including dacryocystorhinostomy, orbitotomy, and eyelid surgeries, were successfully recorded using this setup. All recordings were stable, centered, and of high image quality. Screenshots captured during surgery clearly depicted anatomical structures under standard operating room lighting. This smartphone-based recording method offers a simple, cost-effective, and ergonomically practical alternative to traditional surgical video systems in oculoplastic procedures. Its adaptability, ease of use, and compatibility with sterile environments make it an ideal solution for surgical documentation and teaching, especially in resource-limited settings.

This study aimed to evaluate postoperative outcomes in dogs and cats undergoing eyelid and third eyelid surgeries without routine prophylactic antibiotic use. This observational study included 96 animals (71 dogs and 25 cats) that underwent 163 eyelid and third eyelid procedures between March 2024 and November 2025. Animals were divided into four groups: no antibiotics, topical only, systemic only, or both topical and systemic. Prophylactic antibiotics were administered only when predefined clinical criteria were met, including prolonged surgical duration, breach of aseptic protocol, comorbidities, or concurrent otitis or dermatitis. Postoperative complications were classified according to an adapted Clavien-Dindo system (Grades I-V), based on the level of intervention required. Seventy animals underwent surgery without antibiotics, 12 received topical antibiotics only, four received systemic antibiotics only, and nine received both topical and systemic antibiotics. Two cases of postoperative suture dehiscence occurred: one in a cat from the combined topical and systemic antibiotic group after a Read and Broun procedure, and one in a dog from the no-antibiotic group after a bilateral Kuhnt-Szymanowski procedure. Both were classified as grade II, as they resolved with medical management. Withholding prophylactic antibiotics unless predefined risk factors were present did not increase the rate of postoperative complications in eyelid and third eyelid surgery. A restrictive and rational antibiotic protocol, based on clearly defined criteria, may therefore support responsible antimicrobial use in veterinary ophthalmology.

BackgroundNon-incisional double eyelid surgery is widely performed in East Asia, but crease loss remains a major concern, leading to patient dissatisfaction and revision. The relative impact of surgical technique, anatomical characteristics, and surgeon experience on crease retention has not been fully clarified.MethodsThis retrospective, observational study included 513 consecutive patients who underwent transcutaneous, non-incisional double eyelid surgery between July 2021 and July 2022. Patients were stratified by surgeon experience (<100 vs. ≥100 prior cases). Baseline variables included age, sex, crease design, fixation method, puffy eyelid status, and surgeon experience. Crease loss was defined as the need for revision due to patient-reported fading or disappearance of the crease. Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate predictors of crease survival, including interaction terms for potential effect modification.ResultsOf 513 patients, 264 were treated by beginner surgeons, and 249 by experienced surgeons. Experienced surgeons more frequently used the continuous buried suture method (p < 0.001), whereas baseline characteristics such as age, sex, and crease design were comparable between groups. Overall prevalence of puffy eyelids was 54.5%, with substantial interrater agreement (κ = 0.72). Kaplan–Meier analysis demonstrated significantly superior outcomes with continuous fixation compared to interrupted fixation (log-rankp < 0.001), and with non-puffy compared to puffy eyelids (log-rankp < 0.001). Surgeon experience showed no significant effect (p = 0.441). In multivariable Cox regression, continuous fixation (HR = 0.29, 95% CI 0.19–0.44,p < 0.001) and non-puffy eyelids (HR = 2.47, 95% CI 1.62–3.78,p < 0.001) were independent predictors of crease retention. A significant interaction between fixation method and puffy eyelid was identified (HR = 0.34, 95% CI: 0.13–0.87,p = 0.024), indicating that the protective effect of continuous fixation was particularly pronounced in patients with puffy eyelids.ConclusionFixation method and eyelid puffiness were the primary determinants of crease retention, whereas surgeon experience was not an independent predictor. Continuous fixation provided superior outcomes, especially for patients with puffy eyelids. These findings suggest that, within standardized training systems, surgical technique and individualized anatomical consideration are more critical than case volume for achieving durable results in non-incisional double eyelid surgery.

Elderly patients often undergo dual antiplatelet therapy (DAPT) for cardiovascular conditions, which increases the risk of postoperative bleeding, including after involutional entropion surgery. The management of antiplatelet therapy in the perioperative period remains a clinical challenge that requires careful consideration. This case report aims to discuss the risk of severe postoperative bleeding associated with continuing DAPT during the perioperative period and to emphasize the importance of comprehensive perioperative care in elderly patients undergoing eyelid surgery. A 76-year-old man on DAPT (aspirin and clopidogrel) underwent right involutional entropion surgery. Four days postoperatively, he experienced persistent ocular bleeding requiring hospitalization. Hemoglobin decreased from 12.7 g/dL to 7.5 g/dL, while coagulation parameters remained within normal limits. The patient received a pressure dressing, systemic tranexamic acid, vitamin K, and three units of packed red blood cells. Following cardiology consultation, DAPT was discontinued. The bleeding gradually decreased and completely resolved within six days after DAPT discontinuation. The patient required seven days of hospitalization and blood transfusion due to the significant drop in hemoglobin. No further complications were observed during follow-up. Continuing DAPT during the perioperative period may cause serious postoperative bleeding, even after minor ophthalmic procedures. Careful medication review, multidisciplinary coordination, and patient education are essential to reduce bleeding risk in elderly patients undergoing entropion surgery.

BackgroundThyroid eye disease (TED) is characterized by inflammation of orbital tissue, proptosis, diplopia, and potential changes in facial appearance. TED has been associated with poor mental health and reduced health-related quality of life (HRQOL) due to the combined impact of impaired visual functioning and changes in facial appearance. The study aims to determine the impact of treatments for TED on patients' HRQOL as a measure of comprehensive well-being.MethodsSystematic searches of literature in MEDLINE, EMBASE and CINAHL databases and grey literature sources were conducted. After de-duplication and screening, the modified Downs-and-Black criteria were used to assess the risk of bias. Baseline characteristics, HRQOL-questionnaire data, and mean HRQOL measurements were extracted.ResultsSearches yielded 313 studies from databases and 9 grey literature studies. 23 studies (2023 patients total) were included for quality assessment and data synthesis. Strabismus surgery yielded the greatest improvement in total HRQOL score. Surgical interventions improved visual function QOL (VF-QOL) and visual appearance QOL scores (Ap-QOL).Other medical therapies, including doxycline and selenium were effective for improving Ap-QOL.ConclusionSurgical interventions, particularly decompression, eyelid, and strabismus surgery, improved appearance-related QOL. Immunosuppressive therapy and doxyxycline contributed to progressive functional improvements over time. Longer follow-up durations were generally associated with greater patient-reported benefit from treatments.

To evaluate the incidence of bleeding complications of oculoplastic procedures performed under antithrombotic therapy and local anaesthesia. A prospective study of patients on antithrombotics undergoing pre-septal and post-septal oculoplastic procedures under local anaesthesia over a 12-month period. The type of antithrombotic, surgical details, intra and post-operative complications were documented. Exclusion criteria were high bleeding-risk procedures, such as orbital surgery and dacryocystorhinostomy. 302 patients were included, mean age was 70.7 ± 14.7. years (19 - 98). 77 patients (25.5%) on antithrombotics were advised to continue their medication prior to surgery. The types of antithrombotics taken by patients at the time of surgery were 60.9% antiplatelets, 33.3% anticoagulants and 5.8% combination therapy. Amongst patients who continued taking their oral antithrombotic medications, there was no major intraoperative or perioperative bleeding complications, and no patients required additional surgical or medical reintervention. One self-resolving postoperative bleed occurred after upper-lid blepharoplasty in a patient on aspirin and rivaroxaban. Bleeding rates did not differ between patients who continued antithrombotics and those not receiving antithrombotics (p = 1.00). This study found no incidence of severe bleeding complications in oculoplastic procedures among patients continuing anticoagulant or antiplatelet therapy, consistent with existing literature. Continuation of anticoagulants and antiplatelets appears safe for selected procedures, simplifying patient management and minimizing thromboembolic risk. Emphasis should be placed on meticulous intraoperative haemostasis rather than discontinuation of antithrombotic therapy.

Facial nerve palsy (FNP) impacts the ocular and periocular regions. Preganglionic trigeminal nerve palsy (PrGTP) may complicate preganglionic FNP (PrGFP), resulting in neurotrophic keratopathy (NK), risking corneal sequelae. We present a case series where comprehensive eyelid surgery (CES) to manage the eyelid sequelae of PrGFP, complicated by PrGTP, resulted in the recovery of corneal sensation, avoiding corneal neurotisation surgery (CNS). A retrospective case series of three patients with PrGFP and PrGTP in whom eyelid abnormalities were addressed through CES. Outcome measures include markers of trophic function, including ocular surface integrity as determined by fluorescein assessment of cornea staining and corneal sub-basal nerve plexus density (CSND) via in vivo confocal microscopy where available. Corneal scarring was assessed, and corneal sensitivity was determined via Cochet-Bonnet or corneal wisp testing. Three patients with longstanding PrGFP and PrGTP (mean of 28.3 (range 18-49) months) underwent CES to correct the eyelid sequelae of FNP. On presentation, two out of three cases had a complete absence of corneal sensation, while one out of three had reduced sensation. All cases had absent trophic nerve function. Following CES, trophic function and corneal sensation started to improve on average 19 days and 10 months later, respectively, for the three patients. CSPD had nearly doubled at 6 months postoperatively in the patient who had this assessed. In cases of NK due to PrGTP complicated by PrGFP, CES should be attempted before considering CNS since improvement in corneal sensation and trophic function may occur. CES helps to reduce exposure and may improve corneal sensation regardless of aetiology.

Periocular rejuvenation involves surgical removal of excess skin, fat debulking, or transfer, and optionally includes eyelid ptosis repair or lateral canthal resuspension. Periocular injectables have revolutionized these esthetic treatments, sometimes replacing surgery. We describe our experience with current treatment approaches for periocular rejuvenation of upper and lower eyelids. We extracted data on treatment types and outcomes of all patients treated for periocular rejuvenation of upper and lower eyelids between 2015 and 2020. All patients were treated by a single surgeon (GBS) at three medical centers. Outcome measures included demographic trends, procedural frequencies, age and gender distribution, as well as age-stratified preferences for surgical versus injectable treatments. In total, 1923 patients (mean age 64years, 1340 females [70%]) underwent upper eyelid rejuvenation, and 248 underwent lower eyelid rejuvenation. Upper eyelid ptosis correction was the most common surgery (1048 patients [55%]), followed by blepharoplasty (875 patients [45%]). Transconjunctival fat debulking with skin pinch removal was the most common surgical approach for lower eyelids (158 patients [64%]), followed by transconjunctival alone (40 patients [16%], canthopexy, and fat repositioning. Additionally, 154 patients underwent 231 periocular hyaluronic acid injections, mostly for tear-trough deformity and retro-orbicularis oculi fat pad to conceal deep superior sulcus deformity. These latter patients were significantly younger than those undergoing surgical treatment. Based on our clinical experience, hyaluronic acid (HA) injections were typically selected for patients with good skin tone and minimal fat herniation who preferred a non-surgical approach. Ptosis surgery was performed in over 50% of patients undergoing upper eyelid surgery. Transconjunctival fat debulking with skin pinch removal was the most common surgical approach in our experience. HA injection was particularly useful for correcting deep superior sulcus deformity and was often preferred by patients seeking subtle volume restoration without surgery. Periocular fillers may sometimes be better than lower eyelid blepharoplasty. 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 .

To evaluate the efficacy and safety of autologous labial mucosal grafting for cicatricial entropion, with emphasis on visual outcomes, eyelid correction, symblepharon severity, and complications. A retrospective analysis was performed on 29 patients (38 eyes) who underwent autologous labial mucosal grafting between March 2019 and January 2025. Preoperative and postoperative best-corrected visual acuity, eyelid position (graded 0–4), symblepharon severity (graded 0–3), and complications were compared. All surgeries were completed without severe intraoperative or postoperative complications, and grafts survived well without contraction or necrosis. Overall, best-corrected visual acuity showed no significant change after surgery (P = 0.545). By etiology, the burn-induced group showed a nonsignificant trend toward improvement, whereas the immune-mediated group remained stable. Both entropion and symblepharon scores improved significantly postoperatively (P < 0.05). Subgroup analysis showed greater benefits in burn-related cases compared with immune-mediated etiologies, particularly after a single procedure (P < 0.01). Multiple surgeries conferred no additional benefit. Patients with longer disease duration (≥ 40 months) tended toward better entropion correction, though this did not reach statistical significance (P = 0.097). Autologous labial mucosal grafting effectively restores eyelid structure and function in moderate to severe cicatricial entropion, especially after chemical or thermal burns. With low complication and recurrence rates, it is a safe and reliable option. Larger prospective studies are warranted to confirm long-term outcomes.

Eyelid surgery remains the cornerstone of rehabilitative treatment in patients with thyroid eye disease (TED), addressing both corneal exposure and facial disfigurement that accompany this autoimmune orbital disorder.Over the past five decades, rapid advancements in oculoplastic techniques, surgical sequencing, and biologic therapies have transformed the management of eyelid malpositions in TED.This systematic review and meta-analysis comprehensively evaluated literature from 1975 to 2025, integrating data from 28 studies encompassing 6,745 patients and 12,928 eyelids.The pooled mean improvement in upper eyelid position as margin reflex distance (MRD1) was -3.12 mm (95% CI, -3.48 to -2.77), while lower eyelid correction (MRD2) averaged -1.89 mm (95% CI, -2.24 to -1.56).The overall patient satisfaction rate was 88.4%, with a recurrence rate of 13.7% and complication rate of 9.6%.Levator aponeurosis recession produced the greatest eyelid lowering, whereas spacer grafts and Mller's muscle recession offered superior aesthetic contouring with lower recurrence.Surgeries performed during the inactive phase of TED, particularly following orbital decompression, demonstrated significantly improved outcomes (p < 0.05).The evidence underscores a paradigm shift toward precision-based, patient-centered surgery integrating AI-assisted symmetry mapping, 3D-printed grafts, and biologic modulation (e.g.teprotumumab) to optimize outcomes.Modern eyelid reconstruction in TED now balances functional ocular protection and aesthetic restoration, achieving long-term stability and high patient satisfaction.Despite moderate heterogeneity among studies, this meta-analysis confirms that surgical timing, technique selection, and multidisciplinary coordination remain decisive factors for success.Eyelid surgery in TED is thus reaffirmed as a safe, effective, and evolving therapeutic strategy, where art meets evidence to restore both vision and confidence.

Postoperative eyebrow position change after double-eyelid surgery can affect aesthetic outcomes, but its mechanism remains unclear. This study aimed to investigate the influence of preoperative eyebrow elevation and other factors using the buried-suture technique to reduce confounding from tissue manipulation. This retrospective study analyzed patients who underwent buried-suture double-eyelid surgery performed by the senior author. Eyebrow height was measured pre- and postoperatively using standardized photographs, and changes were compared between groups stratified by preoperative eyebrow elevation. Subgroup analyses were also performed based on crease height, fixation method, sex, and laterality. A total of 108 patients (216 eyelids) were included. The average rate of eyebrow position change across all patients was 4.8%. Patients with marked preoperative eyebrow elevation exhibited more pronounced postoperative eyebrow descent, and all such eyelids showed a downward shift. Subgroup analyses by crease height, fixation method, sex, and laterality revealed no significant differences in eyebrow-position change. Preoperative eyebrow elevation is a strong predictor of postoperative descent. This factor should be considered during surgical planning and patient counseling to improve accuracy in outcome prediction after double-eyelid surgery.

A surge in Group A streptococcus (GAS) infections has been described in the post-COVID-19 pandemic period. We reviewed cases with periorbital GAS infections at our institution during a 14-month period, including cases with necrotizing soft tissue infection (NSTI). A single center retrospective case series was performed at the University Hospital of Copenhagen, Rigshospitalet, during January 2023 to February 2024 including all adult patients referred from secondary centers with a suspicion of periorbital NSTI. All cases were treated for periorbital skin and soft tissue infections with culture-confirmed group A streptococci in an eye swab, a tissue sample or blood cultures. Eleven cases with a median age of 72 (range 55-84) years with periorbital GAS infection were included. Four patients had diabetes, and one patient had eyelid surgery prior to the infection. Pre-admission symptoms included pain, swelling in the periorbital area, fever and/or a sore throat. Patients presented with fever, nausea, and/or confusion and clinical exams were noticeable for erythema and edema of the periorbital area with the eyelids fully closed on the affected side. Two cases had septic shock. Based on CT scans, six cases were diagnosed with pre-septal cellulitis and five cases were suspected of post-septal NSTI, which was confirmed by surgical debridement. The GAS isolates from tissue samples or blood cultures in these five cases were of type MLST 28 / emm 1.0 (M1 clone). Treatment included meropenem and clindamycin (n = 11), intravenous immunoglobulin (n = 4), surgical debridement (n = 5) and hyperbaric oxygen therapy (n = 3). One patient died in the intensive care unit. Two patients have permanently reduced visual acuity. We report an accumulation of cases with pre- or post-septal orbital GAS infections in which the majority had no evidence of immunosuppression or a triggering event such as trauma or surgery. All cases of invasive GAS infections were caused by the M1 clone.

Double eyelid surgery is a common cosmetic procedure that creates a crease in the upper eyelid. Due to insufficient understanding of the procedure, numerous consultations have emerged, placing a heavy burden on plastic surgeons. The rise of large language models (LLMs) offers a potential solution to this issue. This study collected sixteen questions commonly of concern to individuals seeking the surgery via an online questionnaire and assessed the efficacy of fifteen popular LLMs in answering these questions with both English and Chinese inputs. All responses from the LLMs were scored multidimensionally by three expert eyelid plastic surgeons across dimensions including professionalism, patient friendliness, informativeness, practicality, and logical clarity. The scoring results were statistically analyzed using the Friedman test and Nemenyi post-hoc test. With English input, ERNIE-Bot, ChatGPT-4o, and Gemini-2.0-Flash consistently ranked among the top three across most evaluation dimensions. In contrast, Claude-3.7-Sonnet, HuatuoGPT, ZoeGPT, CompliantGPT, and BastionGPT ranked lower across all dimensions, with performance significantly lagging behind the top performers. For Chinese input, DeepSeek-R1 maintained a leading position across all dimensions, forming the first tier alongside DeepSeek-V3, Gemini-2.0-Flash, and ERNIE-Bot. Meanwhile, Claude-3.5-Haiku, ZoeGPT, Llama3.3-70B-Instruct, CompliantGPT, HuatuoGPT, and BastionGPT ranked lower in multiple dimensions, with a significant gap relative to first-tier models. This study demonstrated LLMs' potential as medical consultation tools for double eyelid surgery, providing useful guidance for both English and Chinese users. Future research should focus on fine-tuning LLMs with more specialized medical data and exploring workflows for surgeon-LLM collaboration to validate their clinical utility. 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 .

BackgroundRemoval of the skin and preseptal orbicularis oculi is the initial step in upper eyelid surgery. Preseptal orbicularis oculi removal has been strongly associated with dry eye symptoms due to sluggish eyelid closure and lagophthalmos. We aimed to investigate the effects of concurrent upper blepharoplasty and external levator advancement (ELA) surgery with or without orbicularis oculi resection on dry eye syndrome and eyelid morphology in Southeast Asian populations.MethodsThis prospective, single-centre, double-blind, randomised controlled trial involved 20 Thai patients (40 eyes) with aponeurotic blepharoptosis and excess eyelid skin undergoing combined upper blepharoplasty and ELA surgery. Patients were randomised into a skin–muscle excision group (group A) or a skin-only excision group (group B). Dry eye parameters including tear break-up time, Oxford ocular surface staining, Ocular Surface Disease Index, eyelid appearance, and patient satisfaction were evaluated preoperatively and on postoperative days 7, 30, and 90.ResultsPreseptal orbicularis oculi excision had no statistically significant impact on dry eye parameters, eyelid appearance, or patient satisfaction. For both groups, surgery increased the marginal reflex distance 1 without causing significant lagophthalmos, indicating successful ptosis correction irrespective of muscle excision. There were no discernible differences in postoperative appearance between the two groups, and the patients reported high satisfaction with their treatment.ConclusionsCombined upper blepharoplasty and ELA surgery, with or without resection of the preseptal orbicularis oculi, may be a safe and potentially effective procedure for patients with aponeurotic blepharoptosis and excess eyelid skin. Our findings demonstrate no evidence of a difference in correlation between either of these techniques and postoperative dry eye parameters or eyelid appearance. Further studies with larger sample sizes and longer follow-up periods are warranted.Level of Evidence IThis 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.

Aesthetic eyelid surgery is performed on adults of all ages. Some patients undergo surgery to correct aging problems at an early age, such as 20 or 30 years of age in both sexes. Blepharoplasty is surgery that seeks to rejuvenate the eyelids by remodeling the periocular tissues. It is performed mainly for aesthetic reasons, but in some cases only for visual reasons (functional blepharoplasty) since the sagging of the skin of the upper eyelids can cause a reduction in the visual field. We have been performing the Upper and Lower Blepharoplasty procedure for 30 years with a cutting CO2 laser, either with the titanium tip or with the diamond blade scalpel and the CO2 laser.