Extended “C” myectomy of the lateral orbicularis oculi muscle—A safe and successful method for treatment of “crow's feet”

Abstract

Commonly, patients who seek facial rejuvenation complain about "crow's feet." Botulinum toxin injections can effectively correct such wrinkles but require repeated treatments. A modification of the earlier described vertical myectomy of the lateral orbicularis oculi muscle is presented. The skin at the lateral orbit was elevated, using the temporal approach when performing a forehead or face lift, or medially when only a blepharoplasty was performed. The lateral portion of the orbicularis oculi muscle was identified and dissected. A portion measuring from at least 3 cm to 4.5 cm (average 3.1 cm) in length and averaging 1.1 cm in width was resected in a pattern designed as a reversed "C" A small part (approximately 3 mm) of the muscle was preserved medially to keep the orbicularis oculi muscle in continuity for preservation of the sphincter. All 28 patients treated in our series were free from relapse after follow-up ranging from 1 to 33 months. One patient developed a moderate hematoma that was treated successfully. Only 1 patient required additional fat grafting. The extended "C" myectomy of the lateral orbicularis oculi muscle achieves excellent results and is easily performed in conjunction with a face lift or blepharoplasty with negligible morbidity. Usually no fat grafting is necessary.