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

Abstract

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. The levator musculo-aponeurotic junction was used as our key landmark. With a formula that we developed, the location of fixation relative to this landmark can be predicted preoperatively. Our clinical experience and outcomes with this technique are presented in this study. Our inclusion criteria were Asian patients with mild to severe ptosis with at least fair levator function. Patients with acquired or congenital ptosis, primary and revisional cases were all included. The location for the 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 takes into consideration 1) the amount of elevation of the upper eyelid margin needed, 2) the degree of compensatory brow elevation that is present and 3) eye dominance. One hundred and fifty-six 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 +/- 1mm in the majority of patients. Our aperture revision rate was 2%. This novel technique provides a predictable and reliable approach for upper eyelid ptosis correction in Asian patients.