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The Role of the Orbicularis Oculi Muscle and the Eyelid Crease in Optimizing Results in Aesthetic Upper Blepharoplasty: A New Look at the Surgical Treatment of Mild Upper Eyelid Fissure and Fold Asymmetries

Fagien, Steven M.D.

Plastic and Reconstructive Surgery: February 2010 - Volume 125 - Issue 2 - p 653-666
doi: 10.1097/PRS.0b013e3181c87cc6
Cosmetic: Original Articles

Summary: One of the most common aesthetic and rejuvenative facial plastic surgical procedures performed is upper blepharoplasty. The traditional approaches to this procedure have been conceptually related to the removal of apparent “excess” tissue to enhance the visibility of the pretarsal region and reduce the upper eyelid irregularities and changes that occur with age. Many times, surgery has been performed both bilaterally and similarly on each side without extensive preoperative planning irrespective of the patient presentation and has commonly incorporated the removal of skin, orbicularis oculi muscle, and upper periorbital fat. The orbicularis oculi muscle is excised for a variety of reasons and has, in general, not been considered as an important component that mandates preservation or a potential means with which to further enhance outcomes by manipulation. If upper eyelid ptosis is also present, it may be treated by traditional methods of blepharoptosis repair. Despite this, patients are more often generally pleased with the obvious improvements after surgery with these traditional surgical procedures, yet the changes do not necessarily approach the youthful configuration in some individuals, the asymmetries that they had presented with may persist, and changes might occur that were not anticipated that may detract from the overall aesthetic result. A simple yet comprehensive approach to upper blepharoplasty that considers both the youthful or desired appearance and the management of upper eyelid asymmetries by preservation or selective treatment of the orbicularis oculi muscle and placement of the upper eyelid crease to improve aesthetic outcomes is presented in this article.

Boca Raton, Fla.

From Aesthetic Eyelid Plastic Surgery.

Received for publication March 8, 2009; accepted August 4, 2009.

Disclosure: The author has no financial interest in any of the products, devices, or drugs mentioned in this article. Botulinum toxin type A is mentioned briefly in this article, and Dr. Fagien has served as a consultant to and clinical investigator for Allergan, Inc., and Medicis, Inc.

Steven Fagien, M.D., 660 Glades Road, Suite 210, Boca Raton, Fla. 33431,

©2010American Society of Plastic Surgeons