Conservative Lateral Orbicularis Oculi Myomectomy for the Correction of Crow's Feet Wrinkles

To evaluate the outcomes of a conservative lateral orbicularis oculi myomectomy performed during upper blepharoplasty, with or without concomitant browlift, for the correction of crow's feet rhytides.

This retrospective case series included patients aged ≥18 years who underwent a 1.5 × 1.5 cm conservative lateral orbicularis oculi myomectomy performed by a single surgeon between May 2023 and May 2025. Crow's feet severity was evaluated preoperatively and at final follow-up using the Carruthers Crow's Feet Grading Scale by a masked reviewer. Patient-reported outcomes were assessed using an electronic questionnaire. Only patients with at least 6 months of follow-up and complete satisfaction questionnaire data were included.

A total of 407 patients were included; 282 (69.3%) underwent upper blepharoplasty with concomitant endoscopic browlift, and 125 (30.7%) underwent upper blepharoplasty alone. Significant improvement in crow's feet severity was observed, with median Carruthers Crow's Feet Grading Scale scores improving from 2 to 1 at rest and from 3 to 2 during smiling (both p < 0.001), corresponding to large effect sizes (r = 0.52 and 0.70, respectively). Patients who underwent concomitant browlift demonstrated greater improvement, particularly during smiling (mean reduction, -1.36 vs. -0.88 grades). Overall satisfaction was high (95.3%) and was greater in the combined group (97.9% vs. 89.6%, p < 0.001). Adverse effects were uncommon and predominantly transient.

Conservative lateral orbicularis oculi myomectomy performed during upper blepharoplasty, with or without concomitant browlift, provides significant improvement in crow's feet severity, high patient satisfaction, and a favorable safety profile. Concomitant browlift may further enhance aesthetic outcomes.