Electrosurgical modification of orbicularis oculi hypertrophy

Purpose: To assess two electrosurgical approaches for the modification of o rbicularis hypertrophy that may be used in conjunction with, or separate fr om, lower lid blepharoplasty. The hypothesis to be tested is that purely el ectrosurgical nonexcisional techniques may be used to modify orbicularis oc uli muscle. Methods: Electrosurgical techniques to treat orbicularis hypertrophy with a n "open" and a "closed" technique are described. The open technique is perf ormed in conjunction with transconjunctival blepharoplasty. The closed tech nique requires a 1-mm to 2-mm dermal incision, 2 minutes of surgical time p er eyelid, and a specially insulated and formed electrosurgical needle. A r eview and case series are presented to illustrate and describe the techniqu es and results. Results: Results for both techniques were rated by both patients and surgeo ns using the categories of poor, fair, good, or excellent. The open techniq ue 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 pe rformed on eight patients. Results for patient satisfaction for the closed technique were considered "good" by 4,"excellent" by 2, "fair" by 1, and th e final patient abstained from categorization. Operatings surgeon evaluatio n 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 hy pertrophy. Drawbacks include a significant learning curve, potential cutane ous ulceration, and occasional temporary anatomic distortion as manifested by scleral show. Complications are minimal, and the technique was safe in a ll patients studied.