Upper Eyelid Blepharoplasty With Ptosis Repair by Levator Aponeurectomy

Martin, John J.

doi:10.1001/jamafacial.2015.0198

Cited by 14 publications

(8 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, Martin 12 described an external levator aponeurosis resection technique in adults that reintroduced an algorithmic approach, although the approach remains to be validated in a patient cohort. This work follows the contributions of several investigators that address other challenges of external ptosis surgery.…”

mentioning

confidence: 99%

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Repp¹,

Rubinstein²,

Sires³

2017

JAMA Facial Plast Surg

View full text Add to dashboard Cite

IMPORTANCE External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies. OBJECTIVE To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic ptosis with good levator function. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic. INTERVENTIONSThe technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress on the eyelid between patients. Two millimeters of aponeurosis were resected for every 1 mm of desired ptosis correction. Two sutures were then placed to connect the aponeurosis to the tarsus at predetermined locations. MAIN OUTCOMES AND MEASURES Preoperative predicted (goal) vs actual margin reflex distance-1 (MRD1).RESULTS Twenty-six eyelids of 15 patients (6 men and 9 women; mean [SD] age, 65 years [range, 17-84 years]) met inclusion criteria. The mean follow-up was 189 days (range, 63-343 days). The mean preoperative MRD1 was 0.44 mm (range, −0.5 to 2 mm; 95% CI, 0.18-0.70 mm) compared with the final mean MRD1 of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P < .001). The mean predicted goal MRD1 was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5 mm). The final MRD1 of all eyelids was within 1 mm of the goal MRD1. The mean surgical time per eyelid was 14.6 minutes (range, 10.5-34.0 minutes). Twelve eyelids (46%) did not have intraoperative suture adjustments. CONCLUSIONS AND RELEVANCEIn correcting aponeurotic ptosis, a small-incision levator aponeurectomy incorporating an algorithm and consistent stress on the aponeurosis during resection achieves the goal MRD1 efficiently. The algorithm closely estimates the desired height intraoperatively such that only small intraoperative suture height revisions, if any, are needed. No intraoperative adjustments were made in 12 eyelids, necessitating future studies to determine whether any adjustments are needed.LEVEL OF EVIDENCE 3.

show abstract

mentioning

confidence: 99%

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Repp¹,

Rubinstein²,

Sires³

2017

JAMA Facial Plast Surg

View full text Add to dashboard Cite

show abstract

“…Transcutaneous aponeurotic repair for upper eyelid ptosis was developed by Jones et al and many variations on this technique have been well described in the literature. 2,[6][7][8][9][10][11][12][13][14][15] In our practice, upper blepharoplasty with anterior plication technique is the only and preferred technique for correction of upper eyelid ptosis.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Aesthetic Upper Blepharoplasty With Anterior Plication Ptosis Repair Performed Under General Anesthesia in Facial Plastic Surgery Private Practice

Archer¹,

Perkins²

2018

Am J Cosmet Surg

View full text Add to dashboard Cite

Anterior plication ptosis repair is a well-recognized technique but there is a paucity of literature using this technique in a Facial Plastic Surgery private practice where the majority of ptosis patients are having their repair in conjunction with other major cosmetic facial surgery under general anesthesia. The objective is to evaluate revision rates of combined aesthetic upper blepharoplasty with anterior plication ptosis repair in this practice setting. This study is a retrospective review of patients between 2010 and 2015 in a private practice Facial Plastic Surgery office who underwent primary upper blepharoplasty with and without anterior plication ptosis repair by the senior author (S.W.P). Patients were identified by Current Procedural Terminology (CPT) code. Average follow-up was 15 months with a range of 3 months to 63 months. Main outcome measure was need for skin pinch revision and/or ptosis revision. Three hundred twenty-six patients were identified. Patients were excluded who had previous upper blepharoplasty (n = 48) and less than 3 months of follow-up (n = 53). Patients were categorized into 2 groups: upper blepharoplasty with anterior plication ptosis repair (33 eyelids, 23 patients) and upper blepharoplasty without ptosis repair (402 eyelids, 202 patients). Of patients who underwent upper blepharoplasty with anterior plication ptosis repair, 15% of eyelids (5/33 eyelids) required revision ptosis repair for abnormal eyelid contour. Seventy percent of patients who underwent this technique were under general anesthesia for multiple procedures. Overall, there was a 7% dermatochalasis revision rate (31/435 eyelids). There was no significant difference in dermatochalasis revision rates of upper blepharoplasty with or without anterior plication ptosis repair (P = .07). In our Facial Plastic Surgery private practice, upper blepharoplasty with anterior plication ptosis repair may be safely and effectively performed in conjunction with major cosmetic facial surgery under general anesthesia to address aging dermatochalasis and ptosis.

show abstract

“…In this technique, dermatochalasis is treated by an excision of the re- dundant skin and orbicularis oculi muscle. It is also possible to manipulate the aponeurosis structure through an incision along the upper eyelid crease [1,2,[12][13][14]. However, the incision along the lid crease or supraciliary incision has numerous shortcomings in East Asian patients.…”

Section: Discussionmentioning

confidence: 99%

Medial Crease Formation in Unfavorable Subbrow Excision: Medial Crease in Subbrow Excision

Kwon

Jeong

2015

Arch Aesthetic Plast Surg

View full text Add to dashboard Cite

Background Various surgical techniques have been developed to address senile upper eyelids. Upper blepharoplasty has limited efficacy in natural periorbital rejuvenation for severe lateral hooding of the upper eyelids, as well as often producing a 'surprised look'. Subbrow excision is a popular method in East Asia for the correction of eyelid drooping, especially on the lateral side as periorbital rejuvenation. However, medial upper eyelid skin redundancy often tends to be undercorrected. Here, we present a few cases of revisional blepharoplasty, especially for medial crease formation, to improve aesthetic results. Methods Five patients, for a total of 10 eyelids, who underwent revisional blepharoplasty from January 2011 to January 2015 after a previous subbrow excision, were included. Patients were dissatisfied with uncorrected excessive skin on the medial part of the upper eyelid after a previous subbrow excision; thus, they underwent revisional blepharoplasty for medial crease formation. Results During the follow-up period, patients were aesthetically satisfied with the postoperative results. No patients suffered from any complications during the follow-up period. Conclusions After a previous unfavorable subbrow excision, medial crease formation, via a very minimally invasive technique, could be a favorable option to improve patient satisfaction without postoperative complication or discomfort.

show abstract

Upper Eyelid Blepharoplasty With Ptosis Repair by Levator Aponeurectomy

Cited by 14 publications

References 7 publications

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Surgical Outcomes of Aesthetic Upper Blepharoplasty With Anterior Plication Ptosis Repair Performed Under General Anesthesia in Facial Plastic Surgery Private Practice

Medial Crease Formation in Unfavorable Subbrow Excision: Medial Crease in Subbrow Excision

Contact Info

Product

Resources

About