Role of Orbicularis Oculi Resection in External Levator Advancement for Aponeurotic Blepharoptosis: A Prospective Randomised Controlled Trial
Issued Date
2026-01-01
Resource Type
ISSN
0364216X
eISSN
14325241
Scopus ID
2-s2.0-105028786939
Journal Title
Aesthetic Plastic Surgery
Rights Holder(s)
SCOPUS
Bibliographic Citation
Aesthetic Plastic Surgery (2026)
Suggested Citation
Rojanasakul S., Putthirangsiwong B. Role of Orbicularis Oculi Resection in External Levator Advancement for Aponeurotic Blepharoptosis: A Prospective Randomised Controlled Trial. Aesthetic Plastic Surgery (2026). doi:10.1007/s00266-026-05617-5 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/114480
Title
Role of Orbicularis Oculi Resection in External Levator Advancement for Aponeurotic Blepharoptosis: A Prospective Randomised Controlled Trial
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Corresponding Author(s)
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Abstract
Background: Removal of the skin and preseptal orbicularis oculi is the initial step in upper eyelid surgery. Preseptal orbicularis oculi removal has been strongly associated with dry eye symptoms due to sluggish eyelid closure and lagophthalmos. We aimed to investigate the effects of concurrent upper blepharoplasty and external levator advancement (ELA) surgery with or without orbicularis oculi resection on dry eye syndrome and eyelid morphology in Southeast Asian populations. Methods: This prospective, single-centre, double-blind, randomised controlled trial involved 20 Thai patients (40 eyes) with aponeurotic blepharoptosis and excess eyelid skin undergoing combined upper blepharoplasty and ELA surgery. Patients were randomised into a skin–muscle excision group (group A) or a skin-only excision group (group B). Dry eye parameters including tear break-up time, Oxford ocular surface staining, Ocular Surface Disease Index, eyelid appearance, and patient satisfaction were evaluated preoperatively and on postoperative days 7, 30, and 90. Results: Preseptal orbicularis oculi excision had no statistically significant impact on dry eye parameters, eyelid appearance, or patient satisfaction. For both groups, surgery increased the marginal reflex distance 1 without causing significant lagophthalmos, indicating successful ptosis correction irrespective of muscle excision. There were no discernible differences in postoperative appearance between the two groups, and the patients reported high satisfaction with their treatment. Conclusions: Combined upper blepharoplasty and ELA surgery, with or without resection of the preseptal orbicularis oculi, may be a safe and potentially effective procedure for patients with aponeurotic blepharoptosis and excess eyelid skin. Our findings demonstrate no evidence of a difference in correlation between either of these techniques and postoperative dry eye parameters or eyelid appearance. Further studies with larger sample sizes and longer follow-up periods are warranted. Level of Evidence I: 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.