Upper Lid Blepharoplasty Without Cutting the Orbicularis Muscle

We have compared the aesthetic outcomes of upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle. In addition we evaluated MRI to visualize the differences in the upper eyelids before and after surgery. An interventional randomized double-blind left right study was conducted in 10 patients with upper eyelid dermatochalazis. One side was randomly chosen for incision of the preseptal orbicularis oculi muscle and direct coagulation or resection of fat pockets. The orbicularis oculi muscle of the contralateral side was not incised. Only a soft coagulation was performed on the muscle to induce a septal contraction and push the orbital fat back. All interventions were performed with an Ellman Dual frequency high frequency low temperature unit. Digital photos were taken before and after surgery and patients were asked to fill in a questionnaire to evaluate the surgery itself as well as the aesthetic outcome. In an attempt to objectify these findings, NMR imaging of the orbits was performed before and 6 weeks after surgery. Symptoms scoring was similar in both groups. At 6 weeks post-operation, no significant differences were observed between left and right eye. In conclusion, patients with dermatochalazis but without prominent fat prolapse in the upper eyelid, did not exhibit significant differences after cutting or not the orbicularis muscle to excise orbital fat. Even in cases with moderate fat prolapse, the fat can be pushed back by soft coagulation of the orbicularis and underlying orbital septum. When the preseptal orbicularis oculi muscle is preserved, the risk of hematoma and orbital cellulitis can be limited.