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Histopathological Characteristics of the Orbicularis Oculi Muscle After Lower Blepharoplasty With or Without Myotomy

  • S. LessaEmail author
  • J. Pontello
  • R. Wanick
  • E. Flores
  • W. Costa
  • F. J. Sampaio
Original Article Oculoplastic
  • 17 Downloads

Abstract

Lower blepharoplasty is a challenging aesthetic procedure. Despite advances in clinical and neuroanatomical studies related to orbicularis oculi muscle innervation, no study has examined its histopathological aspects in different lower blepharoplasty procedures. This study aimed to assess changes in the pretarsal muscle complex in patients treated with transcutaneous lower blepharoplasty with orbicularis myotomy versus those treated with transconjunctival blepharoplasty without myotomy.

Methods

A total of 268 patients underwent blepharoplasty performed by a single surgeon: transcutaneous lower blepharoplasty in 112 (41.7%) and transconjunctival lower blepharoplasty with retroseptal access in 156 (58.2%). Subsequent minor blepharoplasty procedures were performed in 32 patients with lower pretarsal orbicularis oculi muscle biopsy. Connective tissue, fibrillar elastic system, nerves, blood vessels, fiber diameter, and sarcomeres were analyzed.

Results

Without myotomy: collagen, 9.46 ± 0.41%; elastin, 7.03 ± 0.62%; blood vessels, 4.25 ± 0.06%; nerves, 5.2 ± 0.55%; fiber diameter, 62 ± 8.0 μm; and sarcomere, 1.9 ± 0.11 μm. With myotomy: collagen, 19.02 ± 1.66%; elastin, 7.88 ± 1.10%; blood vessels, 5.13 ± 0.70%; nerves, 2.9 ± 0.48%; fiber diameter, 49 ± 6.5 μm; and sarcomere, 1.8 ± 0.17 μm.

Discussion

Excess endomysial connective tissue, particularly between muscle fibers, should be considered pathological. The pathological changes in the pretarsal muscle complex after blepharoplasty with myotomy may have resulted from innervation interruptions as well as vascularization blockages.

Conclusions

Surgeries with myotomy caused significant changes in collagen, nerves, and muscle fiber diameter. These observations strongly suggest the superiority of a technique that preserves orbicularis oculi muscle integrity.

Level of Evidence III

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Keywords

Pretarsal orbicular complex Histopathology Myotomy 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All surgical procedures were performed in the author senior private practice and were in accordance with the ethical standards of the institutional and for national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

All persons involved in this study have given informed consent to include muscle sample for scientific or education purpose and for publication of the results of this study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Plastic Surgery DivisionState University of Rio de JaneiroRio de JaneiroBrazil
  2. 2.Department of OpthalmologyState University of Rio de JaneiroRio de JaneiroBrazil
  3. 3.Urogenital Research UnitState University of Rio de JaneiroRio de JaneiroBrazil

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