Blepharoptosis Correction Using Retrotarsal Tucking of Müller muscle – Levator Aponeurosis
Goals/Purpose:
To evaluate the outcome of retrotarsal tucking (advancement) of Müller muscle-levator aponeurosis for correction of upper eyelid ptosis in conjunction with upper blepharoplasty and to explore the relationship between the extent of Müller muscle-levator aponeurosis advancement and change in the eyelid position (MRD1).
Methods/Technique:
The medical records of 290 consecutive patients (256 women and 34 men) who had blepharoptosis correction in conjunction with aesthetic blepharoplasty from February 2005 to November 2011 were reviewed. Of those, 26 patients (51 eyelids) were statistically analysed. The correction was performed through an external upper blepharoplasty approach. Once the orbital septum was opened, Müller muscle-levator aponeurosis was advanced and tucked under the posterior surface of the tarsus by single lifting suture of 6-0 nylon (just medial to the mid-pupillary line). The average follow-up period was 20.6 months.
Results/Complications:
In 26 patients (51 eyelids) who underwent above-described procedure, satisfactory results were recorded for 49 of 51 eyelids (96.1%). The margin reflex distance-1 (MRD1) increased from 1.56±0.70 mm preoperatively to 3.86±0.94 mm postoperatively (p<0.001, Wilcoxon signed rank test). Averagely, when 6.1 mm of advancement was implemented, an MRD1 of 1mm was achieved. For 7.2 mm and 8.3 mm of advancement, the average MRD1 achieved was 2 mm and 3 mm each.
The complications were minor, with one patient (both eyelids) of undercorrection and 3 patients of asymmetry.
Conclusion:
The author concludes that this procedure is one of the most effective surgical options in correcting borderline, mild to moderate blepharoptosis in conjunction with aesthetic blepharoplasty. Advantage of such a method is that once the orbital septum is opened, Müller muscle-levator aponeurosis is easily advanced and tucked under the posterior surface of the tarsal plate without extensive dissection or resection, which is less traumatic and gives a more vertical lifting vector than conventional method, thus producing excellent cosmetic results and quick recovery.
