Overview
Crow's feet are the wrinkles that fan out from the outer corner of the eye with smiling or squinting, caused in part by the orbicularis oculi muscle. The authors reviewed a single surgeon's retrospective case series of patients who had a small, conservative removal of this muscle's outer portion during upper eyelid surgery, with or without an endoscopic browlift, and measured the wrinkle change with a standard grading scale.
Findings
- Retrospective case series, patients 18 years or older, treated by a single surgeon, May 2023 to May 2025.
- Procedure: 1.5 x 1.5 cm conservative lateral orbicularis oculi myomectomy during upper blepharoplasty.
- 407 patients included, with at least 6 months follow-up and complete satisfaction data; 282 (69.3%) also had endoscopic browlift, 125 (30.7%) had upper blepharoplasty alone.
- Crow's feet severity (Carruthers Crow's Feet Grading Scale) improved from a median of 2 to 1 at rest, and from 3 to 2 while smiling (both p < 0.001).
- Effect sizes: r = 0.52 at rest, r = 0.70 while smiling (both considered large).
- Patients who also had browlift showed greater improvement while smiling (mean reduction 1.36 grades vs. 0.88 grades for blepharoplasty alone).
- Overall satisfaction: 95.3%; higher in the combined browlift group (97.9%) than the blepharoplasty-alone group (89.6%), p < 0.001.
- Adverse effects were uncommon and mostly temporary.
What it means for a patient
- Removing a small, specific portion of the eyelid-closing muscle during upper eyelid surgery can meaningfully soften crow's feet, both when the face is still and when smiling.
- Adding a browlift at the same time gave a bigger improvement in smiling wrinkles and higher patient satisfaction than eyelid surgery alone.
- Over 95% of all patients in this series were satisfied, and side effects were uncommon and usually temporary.
- This is a single-surgeon retrospective series without a control group that skipped the muscle removal, so it cannot isolate the myomectomy's effect from the rest of the surgery by itself.
Why this paper matters
It reports measured wrinkle-scale improvement and high satisfaction for a specific, limited muscle-removal technique added to upper blepharoplasty, in the largest reported series of 407 patients.
Terms
- Orbicularis oculi: the muscle that closes the eyelids and encircles the eye, partly responsible for crow's feet when it contracts.
- Myomectomy: surgical removal of a piece of muscle.
- Carruthers Crow's Feet Grading Scale: a standard scale for rating crow's feet wrinkle severity.
- Endoscopic browlift: a brow-lifting procedure done through small scalp incisions using a camera (endoscope).
- Effect size (r): a statistical measure of how large a change is, independent of sample size.