Gender and Patient Preferences: Unraveling the Decision-Making Process for Blepharoplasty Among Males and Females

Introduction

Blepharoplasty, or eyelid surgery, is a cosmetic procedure aimed at improving the appearance of the upper and lower eyelids.¹ With aging, the eyelid skin stretches, muscles weaken, and fat pockets bulge, leading to a tired, sad appearance. Blepharoplasty can remove excess fat, eliminate bags under the eyes, tighten muscles, and remove excess skin for a more youthful, rejuvenated look.² As one of the most popular facial cosmetic surgeries worldwide, blepharoplasty can help patients restore confidence and self-esteem by providing them with a less aged facial appearance.^3,4

Gender differences have been documented regarding motivations to seek plastic surgery in general.⁵ Women pursue the majority of cosmetic procedures, with some evidence that they feel more pressure to achieve unrealistic standards of physical beauty propagated by the media and society.^6,7 Men’s motivations for cosmetic surgery tend to focus more on maintaining a youthful, competitive appearance for workplace success.⁸

Blepharoplasty is one of the most commonly performed aesthetic surgical procedures worldwide.^2,9–11 According to the American Society of Plastic Surgeons (ASPS), blepharoplasty was the 3rd most popular nonsurgical cosmetic procedure and the 11th most popular surgical cosmetic procedure in the United States in 2021.¹² An international multicenter study on cosmetic procedures found blepharoplasty to be the 5th most common surgical procedure globally.¹³

In particular, blepharoplasty procedures have substantially increased over the past two decades.¹⁴ Data from private-practice physicians in the US suggest a 292% overall increase in both upper and lower blepharoplasty procedures from 2000 to 2018.¹⁵ The COVID-19 pandemic only briefly slowed this rapid growth, with blepharoplasty procedures projected to continuously rise in coming years with the aging of large baby boomer populations worldwide.¹⁶ This growth indicates the strong and increasing patient interest in blepharoplasty’s anti-aging effects around the eyes.

Compared to many other cosmetic surgeries like breast augmentation/reduction, body contouring, and liposuction primarily marketed toward women, the sizeable minority of men undergoing blepharoplasty is noteworthy.¹⁷ Male patients still differ from the predominant female demographic in terms of age distribution undergoing blepharoplasty. While women tend to undergo the surgery at younger ages between their 30s and early 50s, most men receive blepharoplasty in their 50s to 60s.^18,19

As blepharoplasty falls under the umbrella category of aesthetic plastic surgery, examining motivations for undertaking cosmetic procedures more broadly can provide context for gender differences in factors affecting decisions about blepharoplasty specifically.²⁰ A substantial body of research has investigated why patients elect to often undergo risky and expensive plastic surgery purely to alter physical appearance.²¹

For female patients across cultures, a predominant motivation is to increase attractiveness and reaffirm a youthful identity in line with unrealistic societal beauty ideals.²² Women describe seeking cosmetic surgery to fulfill external expectations about appearing feminine, comparing their aging looks unfavorably against younger women and media celebrities.²³ Relationship factors also motivate some women, including attempting to attract a partner or spice up a marriage through enhancing beauty.²⁴ Psychological factors like low self-esteem and body image issues additionally predict interest in cosmetic procedures for some female patients.²⁵

Male patients less frequently cite attractiveness as a reason for cosmetic treatments, instead emphasizing goals like maintaining a competitive, youthful vigor in the workplace or social world.²⁶ For men, frown lines, wrinkles, and tired-looking eyes can undermine an appearance of strength needed to exert confidence and authority over peers or younger rivals.²⁷ Nevertheless, rising societal pressures on men to achieve unrealistic media-propagated body and beauty ideals have motivated a rapidly growing number of male patients to seek cosmetic surgery.²⁸

This paper examines how key factors in deciding to undergo blepharoplasty differ between male and female patients. A clearer understanding of gender differences can assist plastic surgeons in appropriately counseling patients about the procedure based on their individual characteristics, goals, and concerns. Tailored patient education and support may increase satisfaction with surgical outcomes.

Method

Study Design

This study was designed as a retrospective analysis conducted in Al Ahsa, Saudi Arabia. The primary aim was to assess the factors influencing the decision to undergo blepharoplasty among male and female patients. The study reviewed medical records of patients who underwent this cosmetic procedure from January 2023 to July 2023. By analyzing patient demographics, motivations, and postoperative satisfaction, the study sought to understand gender-specific factors that affect the choice to have eyelid surgery in this region.

Participants

The participant selection for this study involved a detailed approach incorporating specific inclusion and exclusion criteria alongside a clear sampling strategy to ensure a comprehensive and representative analysis.

Inclusion Criteria

• Adults aged 18 years and older who underwent cosmetic blepharoplasty within the specified study period.

Exclusion Criteria

• Patients with incomplete medical records that lacked key demographic or procedural information.
• Patients undergoing reconstructive blepharoplasty rather than cosmetic surgery.
• Patients with significant eye-related medical conditions, including but not limited to glaucoma, severe dry eye syndrome, previous eye surgeries, or any condition that could have significantly impacted the outcome or decision to undergo blepharoplasty.
• Patients with a history of severe allergic reactions to anesthesia or other surgical complications.
• Patients with untreated mental health disorders that may interfere with postoperative recovery.
• Patients with underlying health conditions such as uncontrolled diabetes or heart disease. These additional criteria have been included in the manuscript.

A purposive sampling strategy was employed to select a balanced cohort of 100 participants, comprising 50 male and 50 female patients. This balance was aimed at capturing a wide spectrum of motivations and outcomes related to the cosmetic procedure, enabling a robust comparison between genders. Participants were categorized based on their age at the time of surgery, with those aged exactly 30 being placed in the 25–30 age group, and those aged exactly 35 in the 30–35 group.

Data Collection

Data collection for this study was conducted in two phases: a retrospective review of medical records and a follow-up survey.

Medical Records Review

Medical records of the selected patients were thoroughly examined to extract relevant data, including demographic details (age, gender), the specific reasons reported by patients for undergoing blepharoplasty, and other clinical details such as the type of blepharoplasty performed and any documented postoperative outcomes.

Follow-Up Survey

A structured questionnaire was administered through face-to-face interviews with the participants to assess postoperative satisfaction and gather qualitative feedback. These interviews were conducted by trained researchers who ensured a standardized approach to data collection.

The follow-up survey aimed to collect qualitative data regarding the patients’ perceptions of the cosmetic outcomes, any changes in self-esteem, social interactions, and the overall impact of the surgery on their daily lives. The survey also explored participants’ satisfaction with the procedure and whether their expectations were met.

Postoperative Care

Patients were advised to use gentle, hypoallergenic skincare products post-procedure. Recommended cosmetics included mild cleansers, moisturizers containing hyaluronic acid for hydration, and sunscreens with SPF 30 or higher to protect the healing skin. In addition, an antibiotic ointment was often prescribed to prevent infection.

Ethical Considerations

The study was conducted in full compliance with ethical research standards. The procedures followed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Approval was obtained from the Ethics Committee of King Faisal University (Ethical Approval Code: ETHICS2243). All participants were provided with detailed information about the study’s purpose, procedures, potential risks, and benefits before obtaining their written informed consent. The confidentiality of participants was strictly maintained, and personal identifiers were removed from the dataset to ensure anonymity.

Statistical Analysis

The data collected from medical records and follow-up surveys were meticulously processed and analyzed using SPSS software (Version 26). Descriptive statistics were utilized to summarize key aspects of the data, including patient demographics, reasons for undergoing surgery, and levels of postoperative satisfaction. These statistics were presented as frequencies, percentages, means, and standard deviations, providing a clear overview of the study population.

The central part of the analysis involved comparing the motivations for undergoing blepharoplasty between male and female patients. This was achieved using chi-square tests for categorical variables, such as the reasons for surgery, and independent Participants t-tests for continuous variables, such as age or satisfaction scores. A significance level of p <0.05 was set as the threshold for determining statistical significance, allowing for the identification of meaningful differences or correlations within the data.

Results

Table 1 presents demographic data for the study’s 100 participants, showing that the majority (53%) are aged 30–35, followed by 34% aged 25–30, and 13% aged 35–40. Gender distribution is evenly split, with 50% male and 50% female participants. Regarding motivations for blepharoplasty, 55% cited social embarrassment, 28% aimed to look younger, 14% were concerned about eye heaviness, and a smaller portion (3%) mentioned marriage considerations as their reason for the procedure. Patients aged 25–30 typically experience more subtle results compared to older age groups. Their results focus on enhancing natural appearance and alleviating mild concerns such as social embarrassment rather than achieving dramatic anti-aging effects. Approximately 15% of the participants reported prior use of Botox injections around the eyes to treat dynamic wrinkles, such as crow’s feet, before opting for blepharoplasty.

Table 1 Demographic Data of the Participants (n=100)

Table 2 outlines the reasons influencing the decision to undergo blepharoplasty among the participants. The most common reason, cited by 55% of participants, was social embarrassment. This was followed by the desire to look younger, which motivated 28% of the participants. Eye heaviness was a factor for 14%, while only 3% of participants indicated that their decision was influenced by upcoming marriage plans.

Table 2 Reasons Affect the Decision

Table 3 and Figure 1 shows the association between age and the reasons for undergoing blepharoplasty among the study participants. Social embarrassment was the most prevalent among the 25–30 age group (43.6%), but decreased with age, being reported by only 16.4% of those aged 35–40. The desire to look younger was highest in the 30–35 age group (78.6%) and significantly lower in both the 25–30 (14.3%) and 35–40 (7.1%) age groups. Eye heaviness was a concern primarily for those aged 30–35 (57.1%), while it was less of an issue for the other age groups. Marriage considerations were most relevant for the youngest group (66.7% in the 25–30 age group), with little to no relevance in older groups.

Table 3 Association Between Age and Reasons

Figure 1 Age effect on decision.

Table 4 illustrates the association between gender and the reasons for undergoing blepharoplasty. Males predominantly cited social embarrassment (63.6%) and eye heaviness (71.4%) as their primary motivations, with fewer males undergoing the procedure to look younger (10.7%) or in preparation for marriage (66.7%). In contrast, females were overwhelmingly motivated by the desire to look younger (89.3%), while social embarrassment (36.4%) and eye heaviness (28.6%) were less common reasons. Marriage considerations influenced a small portion of both genders but were slightly more relevant for males (66.7%) compared to females (33.3%).

Table 4 Association Between Gender and Reason

Discussion

This study aimed to elucidate potential differences between male and female patients in key factors motivating decisions to undergo blepharoplasty cosmetic eyelid surgery. Our matched-Participants analysis of 100 patients revealed several intriguing patterns of variation and alignment across genders and age groups regarding reasons like social embarrassment, youthful appearance, eye heaviness, and marriage considerations. These findings carry meaningful implications for patient counseling and education practices in plastic surgery. This study provides novel insights into gender and age-specific factors influencing the decision to undergo blepharoplasty, particularly in younger patients aged 25–30, a demographic less frequently studied in prior research.

Social Embarrassment Predominates for Younger Patients

Notably, concerns over social embarrassment emerged as the most frequently cited reason overall for pursuing blepharoplasty, indicated by 55% of our total Participants. This motivation proved especially prevalent among younger patients aged 25–30, reported by 43.6% of this subgroup. While younger patients (25–30 years) undergoing blepharoplasty report satisfaction, the results tend to be less dramatic than those observed in older patients. The focus at younger ages is on subtle enhancements and addressing self-consciousness, rather than significant anti-aging outcomes. The prominence of social self-consciousness aligns with research highlighting appearances-based stigma and perceptions of aging as drivers for those seeking cosmetic procedures.²⁹ Our data suggest that such appearance-related social anxieties peak in the late 20s/early 30s then gradually decline with advancing age.

Plastic surgeons should remain cognizant that patients’ feelings of embarrassment or self-consciousness about visible aging signs like droopy eyelids often fuel the decision for blepharoplasty.³⁰ Sensitively discussing these concerns while also providing realistic perspectives on social attitudes can ensure patients hold appropriate expectations pre-surgery.³¹

Desire for Youthful Appearance Strongest Among Women Approaching Mid-30s

Confirming traditional gender norms around cosmetic surgery motivations,³² the desire to reclaim a more youthful facial appearance proved a chiefly female concern in our Participants, cited by 89.3% of women compared to just 10.7% of men pursuing blepharoplasty. Notably, this motivation peaked among female patients ages 30–35, selected by 78.6% of this subgroup.

This pattern coincides with research on rising sociocultural pressures confronting women reaching their mid-30s to adhere to unrealistic beauty standards favoring youth and minimize visible aging signs.³³ Female patients especially appear to undergo dramatic shifts in their self-perceived attractiveness and aging around this life stage based on external expectations.³⁴

Surgeons should remain cognizant that women in their early to mid-30s may feel particularly distressed by eyelid aging signs that clash with youthful beauty ideals.³⁵ Addressing such appearance-related motivations with empathy while also focusing discussions on inner confidence can help ensure female patients in this age group hold realistic expectations about blepharoplasty outcomes.³⁶

Eye Heaviness a Notable Concern Among 30–35 Age Group

Intriguingly, the physical symptom of eye heaviness emerged as a significant motivator for our 30–35-year-old cohort regardless of gender, cited by 57.1% of this subgroup. This pattern points to possible age-related changes in underlying orbital fat structures and eyelid muscles that trigger heaviness/drooping symptoms noticeable enough to drive surgery decisions especially among this age category.³⁷ There is a significant difference in skin texture and elasticity between individuals aged 30 and those aged 60. Younger skin tends to have more collagen and firmness, allowing for subtler rejuvenation, while older skin often shows more pronounced sagging and wrinkles. Blepharoplasty in older patients generally produces more noticeable results due to greater skin laxity, whereas younger patients benefit from more modest changes.

The relative importance of eye heaviness considerations for patients approaching their mid-30s highlights the need for surgeons to carefully evaluate functional vision complaints behind requests for blepharoplasty among this population.³⁸ Thorough pre-surgery screens for orbital disorders or fat displacements contributing to heaviness can improve outcomes for patients motivated by these symptoms.³⁹

Social Perceptions Around Marriage Still Relevant for Some Young Patients

Although an overall minor factor among just 3% of our full Participants, marriage considerations proved a consistent motivation for blepharoplasty among younger subgroups aged 25–30, reported by 66.7% of participants in this age bracket. The decision’s timing around potential marriage plans indicates enduring sociocultural beliefs in some populations that cosmetic surgery can increase marital prospects by enhancing appearance.⁴⁰

This result highlights that facial aging concerns should be discussed sensitively by surgeons within the context of patients’ cultural backgrounds, including for some youthful demographics where beliefs persist around marriageability and cosmetic procedures. Realistic perspectives on likely surgery impacts can help mitigate outstanding expectations.⁴¹

Men Prioritize Functional Reasons; Women Emphasize Cosmetic Reasons

Our data revealed the gender divergence hypothesized by some researchers⁴² regarding functional/medical motivations reported more frequently by male patients and cosmetic motivations predominating for female patients. Specifically, 63.6% of men vs 36.4% women cited social embarrassment concerns, while 71.4% of men vs 28.6% of women reported eye heaviness symptoms.

This aligns with findings that male blepharoplasty candidates often present with more severe dermatochalasis (eyelid drooping) causing peripheral vision deficits.⁴³ Our results confirm men may prioritize functional impairments over appearances in their blepharoplasty decisions, while women focus more directly on cosmetic aging concerns like looking youthful.

These motivational emphases correspond with traditional gender norms but may prove too reductive. Surgeons should avoid overly binary assumptions about motivations, instead clarifying priorities with each patient individually during thorough pre-surgery consultations.⁴⁴

Limitations and Future Research

While providing initial evidence toward gender differences in blepharoplasty motivations, our study contains limitations suggesting directions for future research. Its retrospective cross-sectional design restricted analysis to pre-existing patient data from a single clinical setting. Broader longitudinal observational studies tracking patients’ motivations over their complete surgical journey could provide richer insights. Our Participants also featured a high proportion of younger patients that may not represent typical blepharoplasty demographics. Comparisons utilizing larger, more diverse age Participants would boost generalizability.

Additionally, our reliance on medical records and post-surgery surveys for data collection likely filtered patient responses toward more clinical/functional reasons like eye heaviness versus candid psychological motivations. Incorporating in-depth qualitative interviews could uncover deeper self-perceived motivations. Finally, our Participants contained only patients who had already elected surgery—contrasting candidates who considered but ultimately declined blepharoplasty could reveal key decisional turning points.

Overall, while advancing initial understanding of gender’s role in blepharoplasty motivations, our analysis highlights rich opportunities for more multifaceted, representative research on this increasingly sought-after aesthetic procedure.

Conclusion

This matched-Participants analysis of factors motivating 100 blepharoplasty patients uncovered salient patterns of convergence and variation across gender and age groups. Social appearance concerns predominated among younger patients, while women approaching their mid-30s showed special focus on reclaiming a youthful look. Eye heaviness emerged as a consistent motivator for the 30–35 cohort regardless of gender. Traditional gender norms proved evident, with men focusing more on functional issues and women on cosmetic aging concerns in line with prevailing sociocultural emphases. Yet these binary assumptions may overlook more complex, individualized patient priorities calling for nuanced clinical understandings. By elucidating the diverse mix of motivations behind the decision for eyelid surgery, this study can assist plastic surgeons in adopting targeted, culturally competent approaches to patient education and counseling around blepharoplasty. More research spotlighting patient perspectives can further enrich understandings of this sought-after facial rejuvenation procedure.