ORIGINAL INVESTIGATION Upper Blepharoplasty With or Without Resection of the Orbicularis Oculi Muscle: A Randomized Double-Blind Left-Right Study Renato Wendell Damasceno, M.D., Angelino Ju ´lio Cariello, M.D., Emmerson Badaro ´ Cardoso, M.D., Giovanni Andre ´ Viana, M.D., and Midori Hentona Osaki, M.D. Department of Ophthalmology, Federal University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil Purpose: To compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbic- ularis oculi muscle. Methods: An interventional randomized double-blind left- right study was conducted in 15 consecutive patients with dermatochalasis of the upper eyelid. One side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). The orbicularis oculi muscle of the contralateral side was preserved (group 2). All patients scored differences between both sides on the seventh day, the thirtieth day, and the ninetieth day after the surgery regarding the following symp- toms: edema, hematoma, itching, and pain. Three masked ophthalmic plastic specialists analyzed the aesthetic outcomes by the visual analogical scale. Results: The scoring of symptoms was significantly higher in group 1 than in group 2 on the seventh postoperative day. On the thirtieth and ninetieth days, there were no significant dif- ferences between groups 1 and 2. The analysis by 3 masked observers showed that the aesthetic result was worse in group 1 than in group 2 on the seventh postoperative day. There were no significant differences between groups 1 and 2 on the thirtieth and ninetieth days. Conclusions: Upper blepharoplasty causes more postopera- tive symptoms and presents worse initial aesthetic outcome when the preseptal orbicularis oculi muscle is excised. How- ever, the final aesthetic outcome is the same when the preseptal orbicularis oculi muscle is excised or preserved. (Ophthal Plast Reconstr Surg 2011;27:195–197) D ermatochalasis is a skin excess in the upper eyelid which may be associated with orbital fat prolapse, lacrimal gland prolapse, and involutional blepharoptosis. Upper blepharo- plasty is the gold standard procedure for correction of der- matochalasis. The most common approach to this surgery is the en bloc excision of skin, preseptal orbicularis oculi muscle, and orbital fat. 1–5 In contrast, some authors have recently advocated the importance of saving the orbicularis oculi muscle to pre- serve the youthful fullness of the periorbital region and to prevent the age-related periorbital hollowing. 6–9 The true benefits of both techniques, with or without resection of the preseptal orbicularis oculi muscle, are uncer- tain. Nowadays there is no consensus about the resection of the orbicularis oculi muscle as part of a standard technique for upper blepharoplasty. 9 This study attempts to compare the aesthetic outcomes of the upper blepharoplasty with or without resection of the preseptal orbicularis oculi muscle and saving of the orbital fat. METHODS General Information. A prospective interventional randomized double-blind left-right study was conducted in consecutive patients with dermatochalasis of the upper eyelid. All patients were enrolled in this study from February 1 to March 31, 2009. Exclusion criteria included prior eyelid or orbital surgery, eyebrow ptosis, orbital fat or lacrimal gland prolapse, concomitant ocular disease, systemic comor- bidity, and current use of systemic medications. Research Ethics Committee. This study was approved by the Re- search Ethics Committee. Informed consents were obtained from all participants. This research is in compliance with the tenets of the Declaration of Helsinki. Surgical Technique. First, the upper eyelid crease was marked. The mark was extended from a point above the lacrimal punctum to the lateral canthus. Then, the mark was extended laterally and superiorly as far as the orbital rim. The excess skin estimated using a forceps based at the upper eyelid crease. The marked area of skin was excised, with care taken to leave the orbicularis oculi muscle intact. When the excision of the preseptal orbicularis oculi muscle was intended, the amount of muscle resection was equal to that of the skin removed. Orbital fat was preserved in both sides. Skin of both sides was closed with interrupted sutures of 6-0 monofilament nylon. Data Collection. All patients underwent ophthalmologic examination and preoperative clinical evaluation, including standardized digital photographs (Sony DSLR-A100, Sony Corporation, Tokyo, Japan). 10 Each patient underwent bilateral upper blepharoplasty by the same ophthalmic plastic surgeon. Every surgical step was performed bilaterally and sequentially. After skin resection and adequate hemo- stasis, one side was randomly chosen for resection of the preseptal orbicularis oculi muscle (group 1). In this side, the amount of muscle resection was equal to that of the skin removed. The orbicularis oculi muscle of the contralateral side was preserved (group 2). Orbital fat was preserved in all cases. After muscle resection and additional hemostasis, skin of both sides was closed with interrupted sutures of 6-0 monofilament nylon. All patients were evaluated, photographed, and invited to score differences between both sides on the seventh day, the thirtieth day, and Accepted for publication September 25, 2010. Address correspondence and reprint requests to Renato Wendell Dama- sceno, M.D., Department of Ophthalmology, Federal University of Sa ˜o Paulo, Rua Botucatu 821, CEP 04023-062 Sa ˜o Paulo, Brazil. E-mail: renato.damasceno@unifesp.br DOI: 10.1097/IOP.0b013e318201d659 Ophthal Plast Reconstr Surg, Vol. 27, No. 3, 2011 195