title: Histopathologic findings of the orbicularis oculi in upper eyelid aging: total or minimal excision of orbicularis oculi in upper blepharoplasty.
abstract: OBJECTIVE
  It is well known that gradual loss of elastic fibers and skin relaxation cause the aging process, but whether changes in the orbicularis oculi muscle may contribute to the aging of the upper eyelid is not known. The aim of the present study was to use histopathologic examination to investigate whether the orbicularis oculi contributes to upper eyelid aging.
  
  
  METHODS
  Full-thickness upper eyelids, which were removed during blepharoplasty using en bloc resection, were stained with hematoxylin-eosin and examined. Eleven patients with oriental eyelid, 14 patients with bilateral dermatochalasia, and 2 patients with facial nerve palsy and contralateral dermatochalasia were included in this study.
  
  
  RESULTS
  Patients ranged in age from 21 to 73 years (median age, 55.8 years). Histologic results revealed that changes in the aging upper eyelid were mainly in the skin and subcutaneous layers with large masses of deranged elastic fibers in the papillary dermis, which was characterized as solar elastosis.
  
  
  CONCLUSIONS
  Our study revealed that the entire orbicularis oculi muscle layer remained morphologically intact with aging. Moreover, our findings suggests that a minimally invasive surgical approach with muscle sparing in upper blepharoplasty in selected patients could yield good results in terms of cosmetic outcomes and upper eyelid function while minimizing postoperative complications.
authors.affiliation: Departments of Ophthalmology, Korea University College of Medicine, Ansan, South Korea.
authors.forename: Hwa
authors.initials: H
authors.lastname: Lee
authors.forename: Minsoo
authors.initials: M
authors.lastname: Park
authors.forename: Jongmi
authors.initials: J
authors.lastname: Lee
authors.forename: Eung Seok
authors.initials: ES
authors.lastname: Lee
authors.forename: Sehyun
authors.initials: S
authors.lastname: Baek
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000473:pathology* / Q000502:physiology; D044466:Asian People; D001707:Biopsy, Needle; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000208:ethnology / Q000473:pathology / Q000601:surgery*; D001767:Blinking; D015331:Cohort Studies; D004548:Elasticity; D005143:Eyelids / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D056910:Republic of Korea; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult