Is muscle around eyes excised during blepharoplasty?

Question

I am planing to have upper and lower blepharoplasty to remove eye bags and extra skin on upper lids. Is any muscle around eyes affected, excised or partially excised during the operation? I am doing eye exercises daily to improve my vision (bates method) and want to continue doing so.

Jonathan Kulbersh, MD · Answer

I spare the eye muscles rather than excise them during blepharoplasty, but this depends on patient anatomy and need. Sometimes the muscles have grown so lax that they drag the eyelid downward. Minimal excision and/or tightening may help. It's a minimally invasive surgery and recovery time tends to be quick, with return to normal activities within a few days. I hope this helps.

J. Kevin Duplechain, MD, FACS · Answer

In most cases, it is possible to achieve excellent aesthetic results without removing lower eyelid surgery.  Re-suspending the orbicularis muscle is a preferred technique, and usually results in a much better post operative result because muscle function is preserved.  This is also true in upper eyelid surgery, but sometimes a small strip of muscle can be removed to enhance the upper eyelid crease.  This can however result in some difficulty in closing  the upper eyelid.

Jeffrey B. Wise, MD, FACS · Answer

This is a controversial topic.  The consensus among surgeons who currently perform large numbers of eyelid surgeries is that conservative excision or no excision at all is the preferred practice.  Over-excision can lead to a hollowed out eye and in extreme cases lead to difficulty with eyelid closure.  My advice is to seek the expertise of an experienced eyelid surgeon!Best of luck!

Mehryar (Ray) Taban, MD, FACS · Answer

It is best NOT to remove any eyelid muscle during blepharoplasty.  Removing muscle adds risk to the procedure in terms of eyelid closure, etc.

Leonik A. Ahumada, MD · Answer

Thank you for your question. During lower eyelid surgery there are techniques that divide the orbicularis muscle along its lateral aspect to gain access to the orbital septum and fat pads. This muscle division is then repaired during the closure. Another lower eyelid surgery technique removes the fat without dividing the muscle but instead the muscle fibers are separated to access the fat that may not be completely accessible through transconjunctival approach. In the upper eyelid a narrow strip 1-2 mm of orbicularis muscle is removed in some techniques to help define the upper eyelid sulcus and to access the fat pads. Other techniques simply separate the muscle without removing any in order to access the fat pads. In general the thin muscle resection of the upper eyelid does not affect movement. In the lower lid there can be a loss of tone of the muscle and although this typically recovers it can contribute to lateral scleral show, lid laxity and changing the shape of the eye/aperture. Discuss your concerns with your surgeon in regards to the effect the surgery may have on your muscle exercises.

William Portuese, MD · Answer

On a few occasions, we do excise a small strip of orbicularis oculi muscle when needed. This is for performed for patients who desire  a deeper upper eyelid fold  when patient's have very hooded and thick upper eyelids.  Removing a small strip of muscle is not performed on patient  who have dry eyes. For many examples are more information, please see the link and the video below

William Marshall Guy, MD · Answer

Hello Qning,There are some techniques where the muscle around the eye is partially excised in blepharoplasty.  I am not a fan of those techniques as more conservative approaches with the muscle lead to more predictable and more aesthetic results in my opinion.  Regardless of the technique chosen, the overall function of the eye muscle is not really affected by excising or not excising.  I'd recommend you consult with a facial plastic surgeon to go over your options and learn what is best for you.I hope this helps and good luck.

Jonathan Weiler, MD · Answer

Depends on the case, yes, muscle excision is occasionally done but as techniques evolve we have gone ot more of a muscle preserving technique, but if done these excisions will not effect your vision.Good luck!!

Gaby D. Doumit, MD · Answer

Thank you for sharing your concerns.   Orbicularis oculi muscle (Mucle that close the eyelids) is usually partially excised during upper eyelid surgery.It will not affect you eyelid closure. Good luck

John Harbison, MD · Answer

qning,      Blepharoplasty is somewhat of a variable procedure that differs depending on the patient needs and surgeons' preferences.  Conservative excision of a strip of muscle is not uncommon, but largely depends on your anatomy and desired changes.  It has become less common in blepharoplasty because leaving more muscle under less skin helps contribute to a full, more youthful appearance of the lids in many cases.  I would certainly express your concerns and current therapy with your surgeon prior to the procedure.

Is muscle around eyes excised during blepharoplasty?

Answers (13)

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