Upper Eyelid Ptosis Correction with Levator Advancement in Asian Patients using the Musculoaponeurotic Junction of the Levator as the Key Reference Point

Abstract

Summary: Upper eyelid ptosis correction is a complex procedure. The ethnic differences in the Asian upper eyelid anatomy are compounded by the technical challenges of primary and revision ptosis correction. The authors present a technique of upper eyelid ptosis correction that estimates the exact location of suture fixation that uses the musculoaponeurotic junction of the levator as the reference point. The preoperative considerations in determining the fixation point relative to the musculoaponeurotic junction include the following: A, the extent of ptosis correction needed; B, the degree of compensatory brow elevation with eye opening; and C, eye dominance. The benefits of this approach are the shortened operative time because of more precise preoperative planning and greater predictability and reproducibility of the results. The authors have found that this technique produced consistent and superior results for ptosis correction in Asian patients.

Upper Eyelid Ptosis Correction with Levator Advancement Using the Levator Musculoaponeurotic Junction Formula in White Patients

“…We have previously published our experience with this approach for upper eyelid ptosis correction in Asian patients. 18 , 19 , 28 This article documents our experience with this technique in White patients. Eyelid tissues in White individuals are thinner and lighter, and the levator mechanism may be more effective.…”

“…Plastic surgeons must master levator advancement and be comfortable incorporating it into the upper blepharoplasty procedure, because many patients who present for cosmetic upper blepharoplasty may need a levator advancement incorporated into the procedure to achieve the desired outcomes. 1 , 13 , 14 , 33 , 38 , 39 Patients may have mild blepharoptosis, 18 , 19 , 21 , 28 and appear not to need levator advancement because of apparent adequacy of their palpebral aperture. However, careful examination will often reveal the presence of a subtle but noticeable degree of frontalis straining that is compensating for minor degrees of levator insufficiency.…”

“…Our preoperative estimation of the location of fixation on the levator of the upper eyelid relative to the musculoaponeurotic junction is based on three measures (Table 1 ) 18 , 19 , 28 :…”

“… 26 , 27 In this article, we present a novel formula we developed to determine preoperatively the level of fixation on the levator relative to a constant landmark—the musculoaponeurotic junction of the levator. 18 , 19 Our surgical technique and outcomes with the use of this technique are presented.…”

“…This is a compensatory response to blepharoptosis and has the effect of elevating the upper lid margin. [17][18][19][20][21] For this reason, the degree of frontalis activity with eye opening should be taken into consideration in the preoperative assessment of patients with eyelid ptosis. 22 A further consideration relates to the fact that afferent nerve signaling for eye opening and frontalis compensation is usually not symmetric from both eyes but preferential from one dominant eye.…”