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

Abstract

Introduction: Upper eyelid ptosis correction is a challenging procedure. Here we report a novel approach to this procedure which we have found to be more accurate and predictable compared to conventional approaches. Materials and Methods: A pre-operative system of assessment has been formulated to more accurately estimate the amount of levator advancement required. The levator advancement was referenced from a constant landmark – the musculoaponeurotic junction of the levator. The factors considered include 1) the amount of upper lid elevation required, 2) degree of compensatory brow elevation present 3) eye dominance. Our pre-operative assessment and surgical technique are presented in a series of detailed operative videos. The levator advancement is performed as planned pre-operatively with final adjustment made intraoperatively to achieve correct lid height and symmetry. Results: Seventy-seven patients (154 eyelids) were prospectively analyzed in this study. We have found this approach to be reliable and accurate in predicting the required amount of levator advancement. Intraoperatively the formula correctly predicted the exact required fixation location in 63% of eyelids and to within +/ - 1 mm in 86% of cases. This may be used for patients with ptosis of varying severity, ranging from mild to severe eyelid ptosis. Our revision rate was 4% Conclusions: This approach is accurate in determining the fixation location needed for each individual. This has enabled levator advancement for ptosis correction to be performed with more precision and predictability.