How to determine the amount of levator resection in congenital ptosis repair

Background and objective: Levator aponeurosis resection is an effective technique to correct blepharoptosis when the levator function is fair to good. This study aimed to determine the amount of levator resection in congenital blepharoptosis repair. Methods: This is a prospective case series study conducted in Rizgary teaching hospital and private hospitals in Erbil city, Kurdistan Region, Iraq, from June 2011 to August 2019. The data of 53 patients (64 eyelids) affected by congenital blepharoptosis with poor to good levator function that underwent unilateral orbilateral levator resection blepharoptosis repair through the standard approach were included. The final outcome measures included postoperative eyelid height, contour, and symmetry. Results: This study includes a total of 53 patients with congenital blepharoptosis (64 eyelids); 20 males and 33 females. The age of the patients ranged from 3 years to 54 years, with a mean age ± SD of 14.11 ± 10.66 years. The ptosis was right sided in 22 patients (41.5%), left sided in 20 patients (37.7%), and bilateral in 11 patients (20.8%). The study showed good patient satisfaction in 66.03% of the cases, suboptimal satisfaction in 22.64% of the cases, and poor satisfaction in 11.32% of the cases. Conclusion: The levator resection for congenital ptosis is effective even with poor levator function and replaced in our practice the traditional fascial sling. We recommend that further studies be done on a larger number of patients to investigate the effectiveness of levator resection in patients with severe ptosis and very poor levator function. Keywords: Congenital blepharoptosis; Levator aponeurosis; Levator resection; Levator resection.

Asian Blepharoplasty: The Indian Perspective

The upper eyelid crease is an indentation at the level where fibers from the levator aponeurosis insert into the skin. Typically, Asian eyes are described as creaseless and puffy and the aim of blepharoplasty is to achieve an eyelid crease, without losing the ethnicity of the individual. We aim to describe the most commonly performed technique as well as the peculiar points to be kept in mind from the Indian perspective.

A Modified Approach to Transconjuntival Levator Advancement Offering Intraoperative Options

Background The transconjunctival technique is a preferable and beneficial approach in mild to moderate blepharoptosis repair as without skin incision. However, accurate surgical manipulation of this method is greatly restricted by the poor intraoperative evaluation. Objectives To introduce a modified transconjunctival approach with flexible intraoperative adjustments in order to achieve more accurate ptosis correction. Methods By transconjunctival approach, the levator aponeurosis and the Müller’s muscle were folded using a square-like mattress suture for flexible adjustment and accurate correction. Results In 18 mild ptosis eyelids, 94.5% (17 eyelids) achieved adequate or normal correction. In 9 eyelids with moderate ptosis, 88.9% (8 eyelids) achieved adequate or normal correction. Amongst 24 ptosis patients, 23 (95.8%) achieved good or fair symmetry result. Conclusion We presented a modified transconjunctival technique for repair of mild to moderate ptosis, which is characterized by flexible intraoperative adjustments achieving both satisfying functional and aesthetic outcomes.

Asian Upper Blepharoplasty in Women: A Comprehensive Approach for a Natural and Aesthetically Pleasing Outcome

Background Asian upper blepharoplasty is the most popular cosmetic procedure for Asian women. However, there is lack of standardized approach to this procedure and less than optimal results are still common. Objectives In this article, we introduce our comprehensive approach to Asian upper blepharoplasty in women and report our clinical outcomes with this approach. Methods Our comprehensive approach for Asian upper blepharoplasty in women includes: (1) To determine the height and length of the upper eyelid skin crease; (2) To create a more optimal anatomy of the upper eyelid by removing excess eyelid skin, a portion of the orbicularis oculi muscle and septal fat; (3) To reconstruct the desired anatomic structures of the upper eyelid skin crease through plication of the levator aponeurosis, if necessary, and closure of the upper eyelid skin incision through the septum and the mobile portion of the levator aponeurosis; (4) To add a medial epicanthoplasty if needed to enhance final cosmetic results. Results Over a 5-year period, 332 Asian women underwent upper blepharoplasty for creation of double eyelids, or conversion from less visible to more ideal double eyelids, by the authors with the above comprehensive approach. There were no surgical complications postoperatively and 326 patients (98.2%) rated satisfactory for their outcome during 5-year’s follow-up. Only 6 patients (1.8%) required surgical revision for asymmetry or less optimal shape of the upper eyelid. Conclusions Our comprehensive approach to Asian upper blepharoplasty can be used for Asian women with a natural and aesthetically pleasing outcome and low revision rates.