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

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Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.