Electrosurgical Modification of Orbicularis Oculi Hypertrophy

PURPOSE: To assess two electrosurgical approaches for the modification of orbicularis hypertrophy that may be used in conjunction with, or separate from, lower lid blepharoplasty. The hypothesis to be tested is that purely electrosurgical nonexcisional techniques may be used to modify orbicularis oculi muscle. METHODS: Electrosurgical techniques to treat orbicularis hypertrophy with an "open" and a "closed" technique are described. The open technique is performed in conjunction with transconjunctival blepharoplasty. The closed technique requires a 1-mm to 2-mm dermal incision, 2 minutes of surgical time per eyelid, and a specially insulated and formed electrosurgical needle. A review and case series are presented to illustrate and describe the techniques and results. RESULTS: Results for both techniques were rated by both patients and surgeons using the categories of poor, fair, good, or excellent. The open technique was performed in conjunction with transconjunctival blepharoplasty on 23 patients during 2 years with a minimum follow-up of 6 months. Results for the open technique were considered "excellent" by 14 patients and "good" by 9 patients. The operating surgeons evaluated the improvement as "excellent" in 4, "good" in 11, and "fair" in 8 patients. The closed technique was performed on eight patients. Results for patient satisfaction for the closed technique were considered "good" by 4, "excellent" by 2, "fair" by 1, and the final patient abstained from categorization. Operating surgeon evaluation of the closed technique revealed "excellent" outcomes in 3, "good" in 3, and "fair" for 2 patients. CONCLUSION: Electrosurgical techniques may be used to modify orbicularis hypertrophy. Drawbacks include a significant learning curve, potential cutaneous ulceration, and occasional temporary anatomic distortion as manifested by scleral show. Complications are minimal, and the technique was safe in all patients studied.