Commentary on: The Effect of Hering's Law on Different Ptosis Repair Methods.

Abstract

The author of “The Effect of Hering's Law on Different Ptosis Repair Methods” should be acknowledged for his work studying a series of patients who underwent ptosis surgery.1 Eyelid ptosis presents one of the most confounding challenges to an aesthetic surgeon because often this procedure that seems so simple can have inconsistent results. When I was a fellow years ago with Crowell Beard, he told me, “If it weren't for ptosis, oculoplastic surgeons wouldn't exist.” In our practice, we have found the levator advancement procedure to be the single most effective and consistent procedure to correct small and large amounts of ptosis from many different etiologies. In addition, most adult patients with ptosis also have dermatochalasis and thus would benefit from a blepharoplasty. An anterior approach allows the surgeon to create an eyelid crease as well as to correct the anatomic defect in the dehisced levator tendon and only adds a few minutes to the operative time in experienced hands.2,3 The author presents a creditable discussion regarding the effect of Hering's dependence on the ptosis occurring on the contralateral side after unilateral ptosis surgery. The importance of preoperative evaluation of the ptosis patient cannot be overstated. It is essential, as the author points out, to try to establish the cause of the ptosis—be it aponeurotic, congenital, traumatic, or neurogenic from a Horner's syndrome—and to perform a full exam …