title: Aesthetic and Non-aesthetic Indications for Orbicularis Oculi Myectomy.
abstract: BACKGROUND
  Crows' feet wrinkles are caused by the action of the orbicularis oculi muscle on overlying skin. Treatment options range from botulinum toxin to a multitude of surgical methods. We first described our technique in 2003 and refined it in 2006. We highlight the evolution of our technique and look at our results to assess the effectiveness of our technique.
  
  
  OBJECTIVE
  The aim of this article is to show our experience of 13 years in 134 patients with our technique of orbicularis oculi myectomy.
  
  
  METHODS
  From September 2000 to July 2013, we operated on 134 patients with an age range of 28-77 years. Of these patients, 104 had myectomies via lifting and 22 via a blepharoplasty approach. Five patients had myectomies for treatment of blepharospasm and a further three patients to restore symmetry in facial palsy. An evaluation of the results was performed by two medical students.
  
  
  RESULTS
  Our results showed reduction of the wrinkles in all cases. For the statistical analysis the Wilcoxon test was performed. The p value was less than 0.001 showing a significant reduction of crows' feet wrinkles in both sides when the orbicularis myectomy was performed, via blepharoplasty or lifting. For myectomy performed for blepharospasm or facial palsy, the statistical analysis was not done due to the low numbers.
  
  
  CONCLUSIONS
  In the appropriate patient, orbicularis oculi myectomy is an effective and long-term treatment for crows' feet wrinkles with a low risk of complications and high patient satisfaction.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Department of Plastic Surgery, São Paulo State University Julio de Mesquita Filho, UNESP, Rua Domingos Minicucci Filho, 587, Botucatu, São Paulo, 18607-030, Brazil. fv@faustoviterbo.com.br.
authors.forename: Fausto
authors.initials: F
authors.lastname: Viterbo
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore.
authors.forename: Janna
authors.initials: J
authors.lastname: Joethy
authors.affiliation: Brazilian Plastic Surgery Society, São Paulo, Brazil.
authors.forename: Ryane Schmidt
authors.initials: RS
authors.lastname: Brock
mesh_terms: D000328:Adult; D000368:Aged; D001764:Blepharospasm / Q000188:drug therapy / Q000601:surgery*; D001905:Botulinum Toxins / Q000008:administration & dosage; D015331:Cohort Studies; D004954:Esthetics; D005152:Facial Muscles / Q000187:drug effects / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000187:drug effects / Q000601:surgery*; D012189:Retrospective Studies; D015361:Rhytidoplasty / Q000379:methods*; D018570:Risk Assessment; D015595:Skin Aging; D013518:Surgery, Plastic / Q000379:methods; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins
keywords: Botulinum toxin; Crows’ feet wrinkles; Myectomy; Orbicularis oculi