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

Abstract

BackgroundStandard 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.MethodsA 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.ResultsThere 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.ConclusionsMuscle-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.

Functional outcomes of upper eyelid blepharoplasty: A systematic review

“…13,41 -44 Another theory is that dry eye complaints are prevented by preserving the orbicularis oculi muscle. 45 Although blepharoplasty is performed very frequently in aesthetic surgery, there is no consensus about which procedure is most suited for a blepharoplasty and for which patient. In the review of Hoorntje et al 46 a lack of consensus about what is to be done with the orbicularis oculi muscle in upper eyelid blepharoplasty is demonstrated.…”

“…In theory, left-right comparative studies may result in more evidence-based outcomes. The study of Kiang et al 45 conducted a left-right comparative study where patients were treated with skin-only blepharoplasty on one side and a combined skin-muscle removal on the other side. They concluded that muscle-sparing blepharoplasty may induce less sluggish eyelid closure, less lagophthalmos and less dry eye disease.…”

Upper Blepharoplasty: An Evidence-Based Assessment of Preoperative Considerations and Surgical Techniques

“…In contrast to the previously discussed studies, another prospective split-face study by Kiang et al reported statistically significant adverse outcomes involving the SOM side. 37 In this study, there was a significantly higher incidence of transient lagophthalmos (1 to 6 weeks) and dry eye symptoms (1 week to >6 months) on the SOM side compared with the SO side. Patients demonstrating postoperative lagophthalmos and dry eye symptoms underwent an average orbicularis resection of 15.8 mm, while no lagophthalmos was observed in patients with <10 mm resection (Level 3).…”

Objective quantification of the impact of blepharoplasty on the superior visual field

“…Moreover, from a cosmetic perspective, the areas around the eyes are prominent; therefore, signs of aging are easily seen and may prompt individuals to visit a plastic surgery clinic. Hence, it is well known that upper blepharoplasty, which removes the sagging skin, leads to both cosmetic and functional improvement [ 5 , 6 ].…”

“…However, most studies have measured functional improvement after upper blepharoplasty in terms of patients' subjective self-reports or the superior margin-to-reflex distance 1 (MRD1) before and after surgery, as an objective measurement [5][6][7][8]. Be-Objective quantification of the impact of blepharoplasty on the superior visual field cause the MRD1 is easy to measure and has clear measurement points, it is a useful indicator for predicting the effects of surgery, but it does not exactly reflect the degree of functional impairment caused by pseudoptosis [3,9].…”