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
