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CC BY-NC 4.0 · Arch Plast Surg 2014; 41(05): 576-583
DOI: 10.5999/aps.2014.41.5.576
Original Article

Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

Lee Kiang
Department of Ophthalmology, W.K. Kellogg Eye Center and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
,
Peter Deptula
Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
,
Momal Mazhar
Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
,
Daniel Murariu
Department of Plastic Surgery, University of Virginia, Charlottesville, VA, USA
,
Fereydoun Don Parsa
Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
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Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid.

Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel.

Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected.

Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

Keywords

Blepharoplasty - Ptosis - Dry eye syndromes


Publication History

Received: 18 June 2014

Accepted: 26 July 2014

Article published online:
05 May 2022

© 2014. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • References

  • 1 Rohrich RJ, Coberly DM, Fagien S. et al. Current concepts in aesthetic upper blepharoplasty. Plast Reconstr Surg 2004; 113: 32e-42e
    CrossrefPubMedGoogle Scholar
  • 2 Fagien S. Advanced rejuvenative upper blepharoplasty: enhancing aesthetics of the upper periorbita. Plast Reconstr Surg 2002; 110: 278-291
    CrossrefPubMedGoogle Scholar
  • 3 Hoorntje LE, Lei B, Stollenwerck GA. et al. Resecting orbicularis oculi muscle in upper eyelid blepharoplasty: a review of the literature. J Plast Reconstr Aesthet Surg 2010; 63: 787-792
    CrossrefPubMedGoogle Scholar
  • 4 Zide BM, Jelks GW. Surgical anatomy of the orbit. New York: Raven Press; 1985
    Google Scholar
  • 5 Terella AM, Wang TD, Kim MM. Complications in periorbital surgery. Facial Plast Surg 2013; 29: 64-70
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Sheen JH. Supratarsal fixation in upper blepharoplasty. Plast Reconstr Surg 1974; 54: 424-431
    CrossrefPubMedGoogle Scholar
  • 7 Januszkiewicz JS, Nahai F. Transconjunctival upper blepharoplasty. Plast Reconstr Surg 1999; 103: 1015-1018
    CrossrefPubMedGoogle Scholar
  • 8 Har-Shai Y, Hirshowitz B. Extended upper blepharoplasty for lateral hooding of the upper eyelid using a scalpel-shaped excision: a 13-year experience. Plast Reconstr Surg 2004; 113: 1028-1035
    CrossrefPubMedGoogle Scholar
  • 9 Lelli Jr GJ, Lisman RD. Blepharoplasty complications. Plast Reconstr Surg 2010; 125: 1007-1017
    CrossrefPubMedGoogle Scholar
  • 10 Carroll RP, Mahanti RL. En bloc resection in upper eyelid blepharoplasty. Ophthal Plast Reconstr Surg 1992; 8: 47-49
    CrossrefPubMedGoogle Scholar
  • 11 Thomas CB, Perez-Guisado J. A new approach: resection and suture of orbicularis oculi muscle to define the upper eyelid fold and correct asymmetries. Aesthetic Plast Surg 2013; 37: 46-50
    CrossrefPubMedGoogle Scholar
  • 12 Damasceno RW, Cariello AJ, Cardoso EB. et al. Upper blepharoplasty with or without resection of the orbicularis oculi muscle: a randomized double-blind left-right study. Ophthal Plast Reconstr Surg 2011; 27: 195-197
    CrossrefPubMedGoogle Scholar
  • 13 Parsa AA, Lye KD, Radcliffe N. et al. Lower blepharoplasty with capsulopalpebral fascia hernia repair for palpebral bags: a long-term prospective study. Plast Reconstr Surg 2008; 121: 1387-1397
    CrossrefPubMedGoogle Scholar