Histopathological Characteristics of the Orbicularis Oculi Muscle After Lower Blepharoplasty With or Without Myotomy
- 17 Downloads
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.
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.
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.
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.
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
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.
KeywordsPretarsal orbicular complex Histopathology Myotomy
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
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.
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.
- 1.American Society for Aesthetic Plastic Surgery, Cosmetic Surgery National Data Bank; Statistics 2012. http://www.surgery.org/sites/default/files/ASAPS-2017-stats.pdf
- 3.Beare R (1967) Surgical treatment of senile changes in the eyelids: the McIndoe–Beare technique. In: Smith B, Converse JM (eds) Proceedings of the second international symposium on plastic and reconstructive surgery of the eye and adnexa. Mosby, St. Louis, pp 262–366Google Scholar
- 5.Schwarz F, Randall P (1980) Conjunctival incision for herniated fat. Ophthalmic Surg 11:276–279Google Scholar
- 7.Aston SJ (1988) Skin-muscle flap lower lid blepharoplasty. Clin Plast Surg 15:305–308Google Scholar
- 26.Codner MA, Mc Cord CD (2016) Eyelid and periorbital surgery. CRC Press, Boca RatonGoogle Scholar
- 27.Cumming WJK, Fullthorpe JJ, Hudgson P, Mahon M (1994) Muscle pathology. Mosby-Wolfer, London, pp 15–17Google Scholar