Abstract
Background
The aging process affects skin, muscle and fat of the eyes in a different manner. Their individual rejuvenation would require specific surgical treatment according to their particular demands during lower eyelid blepharoplasty. This would require the separate management of the skin and the muscle by separating them into two different flaps. Basing on the anatomy, during sub-ciliary myocutaneous incision in conventional lower eyelid transcutaneous blepharoplasty most of innervations of the lower orbicularis oculi muscle are transected and denervation sequelae at the pretarsal orbicularis oculi muscle would be expected. However, sub/ciliary approach is still popular. The absence of signs or symptom of denervation of in our large case series even though injury to the motor innervation of the orbicularis oculi muscle during the operation led the authors to investigate the discrepancy between the anatomical concept and clinical outcomes. The study aimed to investigate the residual functionality of the orbicularis oculi muscle after lower eyelid transcutaneous blepharoplasty according to Reidy Adamson-s flap.
Materials and Methods
Ten patients were enrolled in the study. Orbicularis oculi muscle functionality was investigated with electroneurography before and at least 6 months after the surgical procedure. Investigated parameters are: Compound Muscle Action Potential (CMAP) as expressions of quantity of activated muscular fibers by the electrical stimulation of the facial nerve. Pre- and post-op collected data were compared and statistically analyzed.
Results
The mean age was 52.9; minimum follow-up 6 months; twenty eyes were investigated; 1 patient was excluded. Postoperative data did not show any significant reduction in the CMAP at all.
Conclusion
The study suggests that the buccal branch and medial branch of the zygomatic nerve of the facial nerve supplies efficiently to the orbicularis oculi innervation.
Level of Evidence IV
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.
Similar content being viewed by others
References
Griffin G, Azizzadeh B, Massry GG (2014) New insights into physical findings associated with post blepharoplasty lower eyelid retraction. Aesthet Surg J 34(7):995–1004
Furnas DW (1978) Festoons of orbicularis muscle as a cause of baggy eyelids. Plast Reconstr Surg 61(4):540–546
Adamson JE, Mc Craw JB, Carraway JH (1979) Use of a muscle flap in lower blepharoplasty. Plast Reconstr Surg 63:359–363
Carriquiry CE, Seoane OJ, Londinsky M (2006) Orbicularis transposition flap for muscle suspension in lower blepharoplasty. Ann Plast Surg 57(2):138–141
Innocenti A, Melita D, Ciancio F, Innocenti M (2017) Evidence-based medicine: a graded approach to lower lid blepharoplasty. Plast Reconstr Surg 140(3):504e–505e
Choi Y, Kang HG, Nam YS, Kang JG, Kim IB (2017) Facial nerve supply to the orbicularis oculi around the lower eyelid: anatomy and its clinical implications. Plast Reconstr Surg 140(2):261–271
Innocenti A, Mori F, Melita D, Dreassi E, Innocenti M (2017) Effects of orbicularis oculi flap anchorage to the periosteum of the upper orbital rim on the lower eyelid position after transcutaneous blepharoplasty: statistical analysis of clinical outcomes. J Plast Reconstr Aesthet Surg 70(3):385–391
Innocenti A, Melita D, Mori F, Ciancio F, Parisi D, Innocenti M (2017) Discussion: objective outcome measurement after upper blepharoplasty: an analysis of different operative techniques. Aesthet Plast Surg 41(4):987–988
Innocenti A, Mori F, Melita D, Dreassi E, Ciancio F, Innocenti M (2017) Evaluation of long-term outcomes of correction of severe blepharoptosis with advancement of external levator muscle complex: descriptive statistical analysis of the results. In Vivo 31(1):111–115
Di Francesco LM, Anjema CM, Codner MA, McCord CD, English J (2005) Evaluation of conventional subciliary incision used in blepharoplasty: preoperative and postoperative videography and electromyography findings. Plast Reconstr Surg 116(2):632–639
Hidalgo DA (2011) An integrated approach to lower blepharoplasty. Plast Reconstr Surg 127(1):386–395
Di Francesco LM, Anjema CM, Codner MA, McCord CD, English J (2005) Evaluation of conventional subciliary incision used in blepharoplasty: preoperative and postoperative videography and electromyography findings. Plast Recontsr Surg 116(2):632–639
Drolet BC, Sullivan PK (2014) Evidence-based medicine: blepharoplasty. Plast Reconstr Surg 133(5):1195–1205
McCord CD, Shore J, Putnam JR (1984) Treatment of essential blepharospasm: II. A modification of exposure for the muscle-stripping technique. Arch Ophthalmol 102:269
Hwang K, Lee DK, Lee EJ, Chung IH, Lee SI (2001) Innervation of the lower eyelid in relation to blepharoplasty and midface lift: clinical observation and cadaveric study. Ann Plast Surg 47:1–5
Ramirez OM, Santamarina R (2000) Spatial orientation of motor innervation to the lower orbicularis oculi muscle. Aesthet Surg J 20:107
McCord S, Codner M, Nahai F, Hester R (2006) Analysis of the nerve branches to the orbicularis oculi muscle of the lower eyelid in fresh cadavers. Plast Reconstr Surg 118:556–557
Lowe JB III, Cohen M, Hunter DA, Mackinnon SE (2005) Analysis of the nerve branches to the orbicularis oculi muscle of the lower eyelid in fresh cadavers. Plast Reconstr Surg 116:1743–1749 ; discussion 1750–1751. 2005;116:632–639
De Araujo FV, Faiwichow L, Vasconcellos C, Ching AW, Aguiar Menezes MV, Araujo Pereira GH (2017) Electroneuromyographic study of orbicularis oculi muscle for evaluation of denervation after a transcutaneous inferior blepharoplasty with musculocutaneous flap. Eur J Plast Surg 40:11–16. https://doi.org/10.1007/s00238-016-1233-3
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.
Ethical Approval
All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all participants.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MP4 14511 kb)
Rights and permissions
About this article
Cite this article
Innocenti, A., Dreassi, E., Carla, V. et al. Evaluation of Residual Neuro-Muscular Integrity in the Orbicularis Oculi Muscle After Lower Eyelid Transcutaneous Blepharoplasty According to Reidy Adamson-s Flap. Aesth Plast Surg 44, 1577–1583 (2020). https://doi.org/10.1007/s00266-020-01783-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00266-020-01783-2