A Skin Crease Preserving Modification of Open-Sky Mullerectomy for Blepharoptosis Correction

Abstract

Skin Crease Preserving modified open-sky Muller's muscle-conjunctival resection is an effective technique for correcting blepharoptosis, while normalizing the skin crease.

Müller Muscle Conjunctival Resection: A Multicentered Prospective Analysis of Surgical Success

“…1 However, several retrospective series on MMCR have included patients with baseline MRD1 ≤0 mm. 2,5,14,15,18,19,28,29 In the present study, a MRD1 prephenyl of 0 mm was associated with a 60% observed rate of MRD1 success and a 63% predicted rate of MRD1 success. In addition, with each 0.5 mm increase in MRD1 prephenyl, there was a commensurate increase in predicted success (Fig.).…”

“…Studies have defined MMCR success using subjective terminology 2,4 or arbitrary cosmetic scales. 13 In addition, when MRD1 is documented, the outcome most often reported is the change in MRD1 from baseline [3][4][5]7,10,[13][14][15][16][17][18][19] -a measure that does not adequately reflect the likelihood of obtaining a clinically acceptable result. Although racial variations exist for upper eyelid height, 2 standard deviations below the mean normal MRD1 is thought to lie between 2.0 and 2.5 mm, 20,23 and lay observers typically recognize upper eyelid asymmetry when the difference in MRD1 exceeds 1 mm.…”

“…3–5,7,10,13–19 These studies document that, on average, MMCR surgery increases baseline MRD1 by 1.5–2 mm. 3–5,7,10,13–19 Although the purpose of blepharoptosis surgery is to increase MRD1, the mean change in MRD1 is not a telling indicator of operative success. Mean change in MRD1 neither describes how likely a patient is to achieve an acceptable final eyelid height nor does it convey information about symmetry.…”

“…6,8–10 All but two 11,12 MMCR publications have been retrospective, and the vast majority report the mean increase in marginal reflex distance-1 (MRD1) as the main outcome measure. 3–5,7,10,13–19 These studies document that, on average, MMCR surgery increases baseline MRD1 by 1.5–2 mm. 3–5,7,10,13–19 Although the purpose of blepharoptosis surgery is to increase MRD1, the mean change in MRD1 is not a telling indicator of operative success.…”

“…Three studies have incorporated final MRD1 and symmetry when reporting MMCR success. [18][19][20] However, one publication had a limited surgical cohort, 18 and each of these publications was retrospective. Furthermore, only one of these studies went on to assess variables that could influence surgical success.…”