Does the Muscle in Back of Lid Have to Be Cut During Eyelid Surgery?

Question

i'm considering eyelid surgery but after hearing about cutting muscle i think i'll just have some trimmed off lids. Should I see a resonable result? Does the muscle have to be cut to have good results? my vision is not impaired so it will be cosmetic only. i'm 58 years  old and think this will hold me for a while. won't care after 70+. is this a good decision? thanks for your time.

Houtan Chaboki, MD · Answer

Cosmetic eyelid surgery (blepharoplasty) has many variations. Let's focus just on the cosmetic surgery of the upper eyelid. Most plastic surgeons generally remove a small strip of muscle in addition to excess skin for eyelid enhancement. Some eye plastic surgeons may remove the extra skin only. Less commonly, a small amount of fat is also removed from the upper eyelid area. Lastly, some patients have droopy eyelids (ptosis), usually from age, and require tightening of the eyelid. Each technique has its advantages and disadvantages.
Only after a comprehensive evaluation by a specialist can an appropriate upper eyelid surgery be determined for you. Best of luck.

Steven J. Pearlman, MD, FACS · Answer

Each person needs to be evaluated as in individual. Some only have extra skin in their eyelids to be removed. Some have extra fat,while others need their own extra "fat pads" moved to an adjacent area. Third, the muscles should be preserved but sometimes trimmed. The results should last 10 years or more and make you look more youthful and less tired. I suggest you seek out a specialist in facial surgery to determine what is best for you.

Ricardo A. Meade, MD · Answer

No, the muscle does not always need to be cut.  Many plastic surgeons take only skin and leave the muscle untouched.  It is very dependant on what you truly need.  My personal take on the matter is that patients can request what parts of their face get operated on but they probably shouldn't request what techniques are used.  Your surgeon should make the recommendation as to what is best but an educated discussion on the matter will clarify your comfort with your plastic surgeon as he should know a very clear and distinct answer to your question.
Best Wishes.

Mehryar (Ray) Taban, MD, FACS · Answer

You may be talking about performing muscle surgery from a posterior (back of eyelid) approach in order to correct droopy eyelid, which is different than just excising skin from the front (blepharoplasty).  They are each done for a separate reason, depending on the need:  do you have excess skin or is it droopy or both.  I routinely perform both procedures, if needed.

William Portuese, MD · Answer

No, the eyelid muscle is called the orbicularis oculi muscle and is occasionally trimmed of excess muscle. This is to deepen the upper lid fold when necessary. If your desire is to get a deeper fold of the upper lid, then sometimes this muscle can be trimmed. If you want more of a full look the muscle is not trimmed.

Victor M. Perez, MD, FACS · Answer

The answer is depends, your surgeon will examine you and determine what is the problem, based on his examination and experience he/she will recommend a plan of treatment. Some patient will required excision of skin, fat and muscle in different proportions depending on their individual characteristics. If you are one of those patient with increase amount of  muscle and this is not resected, you will not have an optimum result from your surgery.
Good luck in your surgery

Joseph M. Perlman, MD · Answer

Surgery for the upper lid usually requires removing skin and some fat. Some patients have a hollowed out upper eyelid so no fat is removed in them. As a matter of fact ,sometimes fat is placed into the recess in the upper eyelid immediately beneath the bone in the upper eye socket ,to correct the hollowed look.

	For the lower eyelids, less skin is removed but more fat is either removed or repositioned. Since the fat lies beneath the both the upper and lower eyelids, if that is being removed or repositioned, it is necessary to at least cut through the muscleto get to the fat. It's not unusual to remove a small strip of the muscle, but this does not affect the eye muscle movement. This is an external muscle that is circular in shape and is responsible for winking.

Steven Wallach, MD · Answer

Sometimes surgeons trim some of the orbicularis muscle which is directly under the skin. This can help to sharpen the crease. I prefer in most cases to leave it intact to keep the fullness in the eye. which I feel is more youthful looking.

Kamran Khoobehi, MD · Answer

Upper eyelid surgery usually involves excision of the orbicularis muscle. This is to remove the excess tissue that is sagging and prevent too much fullness .
The techniques for the eyelid surgery will vary from patient to patient also surgeons experience

Peter A. Aldea, MD · Answer

Your question does not specify Upper or Lower lid NOR the technique to which you may be referring.
Directly under the thin skin of the upper and lower lids in an omega-shaped thin muscle, orbicularis oculi, which closes the eye shut. The lateral portion of this thin flat muscle causes the Crow's Feet wrinkles (as well as pulling the side of the brow down)).
UPPER LID - To remove excessive amounts of excess upper lid skin BOTH upper lid skin and a small segment of the underlying Orbicularis are removed. When the lid is puffy excess fat is removed as well.
LOWER LID - 3 different eyelid procedures may be performed:1. Skin "pinch" - through a (subciliary) under the lash line incision a narrow sliver of skin ONLY is removed without incising or going through the muscle.2. Trans cutaneous - Through the same incision, taken through skin and muscle and septum, the fatty bags are approached and treated.3. Transconjunctival - the fat bags are approached through an incision through the inner moist lining of the lower lid and lower lid pulling muscles. The septum, the orbicularis muscle are not incised.
The method applicable in your case would depend on your presentation/physical examination, your cosmetic wishes and your surgeon's preference.
You should get more than one opinion and go (or not) with the surgeon you are most comfortable with.
Dr. P. Aldea

Does the Muscle in Back of Lid Have to Be Cut During Eyelid Surgery?

Answers (13)

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