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—Dr Small, who is a skilled and well-respected oculoplastic surgeon, has made some excellent points with regards to the continued use of the Reynolds procedure.As Small points out, neither the Reynolds procedure, nor facial muscle stripping, nor the newer botulism injection, is curative. Small indicates that he is able to selectively avoid the branches of the facial nerve to the lip to avoid drooping of the mouth. This is in contrast to our experience, which has been that in many cases there is an anastomotic vertical branch from the facial nerve branch to the lip to the eyelid and it may be impossible to dissect peripherally enough to observe the branch of the nerve to the upper lid. Also it was our experience with the Reynolds procedure that in those cases without some upper lip paralysis (which usually proved to be temporary) the incidence of recurrence
McCord CD. Essential Blepharospasm-Reply. Arch Ophthalmol. 1984;102(7):973. doi:10.1001/archopht.1984.01040030780016