Background: The actual benefit of resecting of the orbicularis oculi muscle (OOM) in standard blepharoplasty has been questioned in several studies. A significant concern about strip resection of OOM is the addition of more morbidity to the patient's recovery period with potentially equivalent aesthetic outcomes. Objective: The current study aimed to identify patients need upper eyelid blepharoplasty, determine the procedure of choice for patients with changes in periocular region, demonstrate the technique of skin excision only versus skin and OOM excision in blepharoplasty and compare between two techniques as procedures for facial aesthetic surgery. Patients and methods: A randomized controlled clinical trial was conducted at the Plastic and Reconstructive Surgery Department in Zagazig University Hospitals. During the study period (6 months) a total of 24 cases were subjected to upper blepharoplasty. Participants were divided into 2 groups; skin excision only (12 cases) versus skin and OOM excision (12 cases). Results: Edema, hematoma, itching, and pain scores were significantly higher among skin and OOM group compared to skin group. There was a significant difference between the two studied groups regarding 7 days postoperative VAS. Moreover, there were no significant differences regarding 3 months and 6-months postoperatively. Conclusion: Patients who undergone OOM excision had higher satisfaction, less surgical adverse effects, higher VAS score and higher postoperative symptoms than patients who undergone skin only excision.