title: Muscle-sparing blepharoplasty: a prospective left-right comparative study.
abstract: 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.
authors.affiliation: Department of Ophthalmology, W.K. Kellogg Eye Center and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Kiang
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Deptula
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
authors.forename: Momal
authors.initials: M
authors.lastname: Mazhar
authors.affiliation: Department of Plastic Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Murariu
authors.affiliation: Department of Surgery, Division of Plastic Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA.
authors.forename: Fereydoun Don
authors.initials: FD
authors.lastname: Parsa
keywords: Blepharoplasty; Dry eye syndromes; Ptosis