Levator advancement technique for eyelid ptosis.

There have been many procedures advocated for the treatment of eyelid ptosis. The technique advocated in this paper consists of careful dissection and identification of anatomic landmarks, including preaponeurotic fat, Whitnall's superior transverse ligament, and the vertically oriented blood supply of the levator muscle. The attachment of the levator muscle into the cephalad portion of the levator muscle into the cephalad portion of the levator aponeurosis can be identified and easily dissected in order to perform the procedure of detachment and advancement to the tarsal plate. This procedure for ptosis has been successful in management in moderate to severe ptosis and in some cases has actually increased the muscle function, thereby enhancing the result. In this technique, the full length of levator muscle remains, so maximum excursion is achieved postoperatively. In addition, this surgical approach may be utilized for levator-lengthening procedures in cases of thyroid exophthalmus or overcorrected ptosis simply by performing the reverse procedure of detachment and insertion of a spacer based on the same ratio. Good results have been achieved in over 20 patients, with the exception of two patients who had absent to poor function and in whom undercorrection was present postoperatively.