AIM: To compare the correlation between three-dimensional stereophotography (3D-SPG) and visual analogue scale (VAS) in the evaluation of periorbital swelling after upper blepharoplasty, and to provide a basis for postoperative swelling monitoring and recovery evaluation.

METHODS: This retrospective study included 39 patients who underwent upper blepharoplasty between December 2024 and April 2025. On postoperative days 1, 7, 14, and 28, 3D-SPG was used to measure objective morphological volume and double-eyelid fold width, while periorbital swelling experienced by the patients was assessed using a visual analogue scale. Changes in objective morphological volume and VAS scores from their baseline levels were calculated. Repeated measures analysis of variance was used to assess changes over time, and Pearson correlation analysis was used to evaluate the correlation between objective morphological volume and VAS scores. Standardized response mean (SRM) was calculated to compare the responsiveness of the two parameters.

RESULTS: During the postoperative 28-day period, the double-eyelid fold width, VAS score, and objective morphological volume decreased significantly over time (all p < 0.001). There was a significant positive correlation between the objective morphological volume and VAS score in the early postoperative period (d1–d7) (left eye: d1 r = 0.467, p = 0.003; d7 r = 0.546, p < 0.001; right eye: d1 r = 0.449, p = 0.004; d7 r = 0.497, p = 0.001). At late postoperative days (d14–d28), the correlation weakened and became not statistically significant (left eye: d14 r = 0.098, p = 0.555; d28 r = 0.175, p = 0.286; right eye: d14 r = 0.254, p = 0.119; d28 r = 0.113, p = 0.494). Sensitivity analysis showed that both parameters demonstrated high responsiveness in the early intervals (d1–d7 and d7–d14). However, 3D-SPG maintained consistently higher responsiveness throughout the observation period (SRM = 3.406–5.007), whereas VAS showed a decline in responsiveness in the late interval (d14–d28), potentially due to a floor effect (SRM = 0.902–1.355).

CONCLUSIONS: Both 3D-SPG and VAS demonstrate distinct performance characteristics across postoperative stages. 3D-SPG provides objective, quantitative volumetric data, while VAS captures patient-perceived symptoms. These findings suggest that both methods assess different dimensions of postoperative swelling. However, further studies are needed to determine whether their combined use offers additional clinical benefit.