Physiological strategy for treatment of mild and moderate upper eyelid with ptosis

Abstract

Objective Patients with mild or moderate blepharoptosis performed with double eyelid operation only will lead to high complication rates, such as eyelid crease disappearance, unphysiological appearance. In such cases, utilizing levator aponeurosis can create more physiological double eyelid and correct blepharoptosis in the meantime. Methods Levator aponeurosis is utilized as connecting tissue to transmit dynamic motor of levator muscle to upper eyelid. Levator advancement was performed at the same time to correct blepharoptosis. Results A total of 74 patients (125 eyes) were operated on in this study. 117 eyes (93.6%) showed adequate blepharoptosis correction results, 8 eyes (6.4%) showed inadequate correction results. Sixty six cases (89.2%) showed good symmetry results, 5 cases (6.8%) showed fair results, 3 cases (4%) showed bad symmetry results. One hundred and fourteen eyes (91.2%) showed stable crease, 11 eyes (8.8%) showed fair results, no disappearance result was observed in this study. No scar hypertrophy or blepharoptosis on the upper eyelid was encountered. Conclusions This new technique uses pretarsal levator aponeurosis to connect levator muscle and upper eyelid skin, it transmits the dynamic power of the levator muscle to the lid skin directly, which created palperbral crease more anatomically and physiologically. In the meantime, levator advancement can be performed to correct blepharoptosis. Furthermore, skin adhesion is formed between levator aponeurosis and dermis in a plane planar manner, allowing for more stable palperbralpalpebral crease and more preserved, and preserving orbicularis oculi in situ, leaving no gap in skin and thus reducing eyelid scar formation. Key words: Double eyelid; Blepharoptosi; Levator muscle; Tarsal plate