The adverse effects of frontalis muscle hyperactivity on Asian upper blepharoplasty outcomes: A prospective randomized controlled trial.

[BACKGROUND] Common complications of upper blepharoplasty include significant changes in crease height and disappearance. These issues are frequently observed in patients with overactive frontalis muscles.

[OBJECTIVES] This study aimed to evaluate the impact of frontalis muscle hyperactivity on surgical outcomes.

[METHODS] Crease height was categorized as apparent or true. In this prospective comparative study, 58 patients were randomly assigned to one of two groups: the experimental group received incisional upper blepharoplasty along with botulinum toxin injections into the frontalis muscle 2 weeks before and 6 months after surgery, while the control group underwent incision-based upper blepharoplasty alone. Relevant outcome indicators were assessed and compared between the two groups at 3, 6, and 12 months postoperatively.

[RESULTS] At 6 months postsurgery, significant differences were observed between the two groups in the variations of apparent crease height at the mid-pupil and true crease height at the lateral canthus. By 12 months, significant intergroup differences were also noted in the variations of true crease height at both the lateral and medial canthus and apparent crease height at the lateral canthus and mid-pupil, as well as in the rate of crease disappearance.

[CONCLUSIONS] Hyperactive frontalis muscles adversely affect the outcome of upper blepharoplasty.