Association between the COVID-19 pandemic and granuloma formation following lower blepharoplasty.

Purpose: We hypothesize that lower blepharoplasty post-operative granuloma formation increased during the COVID-19 pandemic. Observations: Retrospective consecutive case series of first-time lower blepharoplasties performed at an academic private practice. Odds ratios of post-operative granuloma formation before and after the onset of the COVID-19 pandemic were analyzed using a logistic regression model controlling for age, gender, and surgical approach. 547 subjects underwent lower blepharoplasty between 2018 and 2023. Their average age was 64.6 (±10.3) years, 73 % were women. 222 (40.6 %) subjects underwent lower blepharoplasty by transconjunctival surgical approach with 290 (53.0 %) by transcutaneous approach. The odds of developing post-operative granuloma during the pandemic period were 2.188 (95 % CI 1.061, 4.513, p = 0.03) times higher than prior to the lockdown period. Increased age was associated with higher odds of post-operative granuloma formation: OR 1.085 (95 % CI 1.05, 1.122, p < 0.0001). Finally, a transconjunctival surgical approach was associated with a 2.525 (95 % CI: 1.415, 4.507, p = 0.01) times higher odds of granuloma formation than was the transcutaneous approach. Conclusions and Importance: We observed an increased odds of post-operative granuloma formation following lower blepharoplasty during the COVID-19 pandemic period. This signal may guide future surgical approaches to reduce post-operative granuloma such as utilizing intraoperative steroid injection and limiting fat manipulation. Further scientific investigation is warranted to evaluate etiology and avoidance.