title: Long-term enhancement of botulinum toxin injections by upper-eyelid surgery in 14 patients with facial dyskinesias.
abstract: OBJECTIVE
  To determine the effects of upper-eyelid surgery (limited myectomy, blepharoplasty, and levator aponeurotic advancement) on patients who demonstrated a suboptimal response or residual heaviness of the upper eyelids after botulinum toxin eyelid injections for facial dyskinesia.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Charts of 358 patients with a diagnosis of benign essential blepharospasm, Meige syndrome (with eyelid involvement), and hemifacial spasm were reviewed.
  
  
  METHODS
  Data were retrospectively analyzed and included subjective and objective responses about botulinum toxin injections (number and duration of effect of injections before and after eyelid surgery).
  
  
  RESULTS
  Of 358 patients with facial dyskinesias, 14 (3.91%) underwent upper-eyelid limited myectomy with or without upper-lid blepharoplasty (n = 5), upper-lid blepharoplasty alone (n = 6), or levator advancement with or without blepharoplasty (n = 3). Mean subjective improvement was 68.75% after limited myectomy combined with blepharoplasty and 58.33% after levator and/or blepharoplasty surgery. Average duration of effect of injections increased from 122.1 days in the patients prior to undergoing eyelid surgery to 210.5 days after surgery.
  
  
  CONCLUSIONS
  Upper-eyelid surgery, including limited myectomy, enhanced the effect of the botulinum toxin in this small group of patients. Patients with a suboptimal response to injections in terms or moderate to marked dermatochalasis with subjective heaviness of the eyelids, upper-eyelid blepharoplasty, and/or limited myectomy should be considered.
authors.affiliation: Department of Ophthalmology, University of Medicine and Dentistry, New Jersey Medical School, Newark 07103-2499, USA. jam1024@aol.com
authors.forename: J A
authors.initials: JA
authors.lastname: Mauriello
authors.forename: R
authors.initials: R
authors.lastname: Keswani
authors.forename: M
authors.initials: M
authors.lastname: Franklin
mesh_terms: D000368:Aged; D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage*; D019882:Blepharoplasty / Q000379:methods; D001764:Blepharospasm / Q000188:drug therapy* / Q000601:surgery*; D001905:Botulinum Toxins / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005143:Eyelids / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019569:Hemifacial Spasm / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008538:Meige Syndrome / Q000188:drug therapy* / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins