Numerical Correlation of Levator Advancement in Preoperative Planning

Three-Point Vertical Mattress Suture: A Simple Technique for Mild Blepharoptosis Correction in Partial-Incision Double-Eyelid Surgery

The aim of this study was to introduce a simple technique for mild blepharoptosis correction using a three-point vertical mattress suture in partial-incision double-eyelid surgery. The medical records and preoperative and postoperative images of 57 patients who underwent simultaneous mild blepharoptosis correction and partial-incision double-eyelid surgery from January 2018 to July 2021 were retrospectively reviewed. The surgical procedure mainly involves three small incisions in the proper eyelid crease, levator aponeurosis exposure by conservative dissection, and three-point vertical mattress suture to plicate levator aponeurosis and fix the orbicularis muscle with the plicated levator aponeurosis. All patients underwent bilateral partial-incision double-eyelid surgery: 10 unilateral and 47 bilateral blepharoptosis corrective surgeries. The average age was 25.3 ± 7.4 years. The mean operative and follow-up duration were 50 minutes and 13 months, respectively. The pre- and postoperative mean marginal reflex distance was 3.04 ± 0.27 and 3.75 ± 0.35 mm, respectively. The overall surgical success rate was 93%. Complications including undercorrection (5.3%), asymmetry (7.0%), and double-eyelid crease disappearance (5.3%) were reported. Three-point vertical mattress suture is considered an effective, safe, and simple technique for mild blepharoptosis correction in partial-incision double-eyelid surgery.

A Comprehensive Approach to Asian Upper Eyelid Ptosis Correction: The Levator Musculo-Aponeurotic Junction Formula

BACKGROUND

The unique anatomy of the Asian upper eyelid requires specific adaptation to the levator advancement technique for ptosis correction to achieve predictable and reproducible outcomes.

OBJECTIVES

The levator musculo-aponeurotic junction was employed as they key landmark. With a formula developed by the authors, the location of fixation relative to this landmark can be predicted preoperatively. The authors' clinical experience and outcomes with this technique are presented.

METHODS

Inclusion criteria were Asian patients with mild to severe ptosis with at least fair levator function. Patients with acquired or congenital ptosis and primary and revisional cases were all included. The location for placement of the advancement sutures was measured from the musculo-aponeurotic junction of the upper eyelid levator. This distance was determined by a formula that considers (1) the amount of elevation of the upper eyelid margin needed, (2) the degree of compensatory brow elevation present, and (3) eye dominance.

RESULTS

A total 156 Asian patients were included in this prospective study. Of these, 148 were bilateral and 8 were unilateral corrections. The technique was predictable with resolution of symptoms of eyelid ptosis post-surgery and good long-term symmetry of the palpebral aperture and crisp upper eyelid creases. The formula for estimating the fixation point on the levator was accurate to within ±1 mm in the majority of patients. The aperture revision rate was 2%.

CONCLUSIONS

This novel technique provides a predictable and reliable approach for upper eyelid ptosis correction in Asian patients.

LEVEL OF EVIDENCE: 4

Factors that influence the postoperative upper eyelid position following surgery for involutional blepharoptosis

External levator advancement is commonly performed for involutional blepharoptosis repair; however, it is difficult to predict the postoperative upper eyelid position (UEP) accurately in blepharoptosis surgery. The purpose of this study was to determine the factors that influence postoperative UEP following surgery for involutional blepharoptosis. We retrospectively studied 40 Japanese women (80 eyelids) who underwent bilateral external levator advancement surgery. We used digital analysis software to measure the UEP and the eyebrow position from straight-gaze view photographs. Statistical analysis was performed to determine the correlation between postoperative UEP and related factors, including age, levator function, amount of levator advancement, anatomical fixed position, and preoperative and intraoperative UEP. We also compared UEP changes in mild, moderate, and severe ptosis groups. Levator function affected both preoperative and postoperative UEP. The amount of levator advancement and the anatomical fixation position on the aponeurosis did not affect the postoperative UEP. However, both preoperative (r = 0.49) and intraoperative (r = 0.55) UEPs affected the postoperative UEP. In cases of severe ptosis, there was significant re-drooping after surgery, while in cases with mild ptosis, the intraoperative eyelid position was maintained or slightly elevated. In involutional blepharoptosis, the degree of preoperative and intraoperative UEP contributed to the postoperative eyelid position. These data suggested that the levator muscle function is a major contributing factor in the pathogenesis of involutional blepharoptosis.

Role of Orbicular Oculi Muscle Resection in Double Eyelid Surgery to Correct Ptosis of Young Adults: A Retrospective Review in 121 Chinese Patients

BACKGROUND

A plump single eyelid with ptosis is the morphological feature of Asians. Orbicularis oculi muscle (OOM) technique can correct ptosis and get a good appearance.

METHODS

A retrospective study was conducted in 121 Chinese patients who underwent double eyelid surgery with medial epicanthoplasty using OOM resection technique from December 2016 to December 2019. Preoperatively, all the patients had good or excellent levator function while skin fold overlapping the upper eyelid margin was found. Palpebral fissure height, upper eyelid margin reflex distance, complications, and cosmetic results were evaluated. Comparisons were performed preoperatively and postoperatively.

RESULTS

The study included 121 patients. Mean follow-up time was 12.8 months (range, 6-32 months). Mean margin reflex distance increased from 1.96 ± 0.60 mm preoperatively to 3.74 ± 0.50 mm postoperatively (P < 0.001), mean palpebral fissure height increased from 6.31 ± 0.51 mm preoperatively to 8.33 ± 0.52 mm postoperatively (P < 0.001). Most patients obtained satisfactory results. Only 1 patient was under correction, 2 patients were with mild asymmetry 6 months postoperatively.

CONCLUSIONS

Ptosis of the upper eyelid can be corrected by the OOM resection technique without any procedure on levator muscle. This technique can be an alternative method for the correction of ptosis of the upper eyelid.