Accurate Application of the Levator Palpebrae Superioris Anterior Migration and Shortening Technique in Blepharoptosis Correction Surgery

Abstract

ABSTRACT Background Accurate preoperative evaluation of the levator palpebrae superioris (LPS) strength is required for specific calculation of anterior migration or shortening. This information serves as a surgical reference for more accurate correction of ptosis. Methods Between June 2017 and June 2019, 155 eyes of 97 patients were studied. Patients were divided into the following 3 groups based on the ptosis degree: mild (28 cases), moderate (53 cases), and severe (16 cases). The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening. The LPS aponeurosis and Muller's muscle (L-M) complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach. The complex was subsequently fixed to the planned tarsal plate location. The upper eyelid margin (UEM) height, eyelid morphology, eyelid closure, eye symmetry, exposure keratitis status, and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively. Results In all cases, the UEM positions were normal, and only patients with severe ptosis exhibited lagophthalmos in the early posterative period. Six months postoperatively, 13% of eyes in the severe group had residual ptosis; all mild and moderate cases exhibited good surgical outcomes. The eyelids closed well with no exposure keratitis. All patients were satisfied with the eyelid contour. Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment. These procedures not only reduce operation time but also enhance the stability of postoperative correction.