Ptosis Correction Through Anterior Displacement of Levator Aponeurosis Within the Corneal Region

Abstract

Background

Upper eyelid ptosis is a common aesthetic concern among Asian patients, resulting in a tired and drowsy appearance that affects their attractiveness. The levator advancement technique is widely used for ptosis correction; however, achieving precise results remains challenging.

Objectives

This study introduces a modified approach to improve the accuracy of levator aponeurosis advancement by focusing on precise measurements and anterior displacement within a defined corneal range.

Methods

The study included patients with mild to moderate ptosis. We measured the mean margin reflex distance 1 (MRD-1) preoperatively and 12 months postoperatively. Histological evidence was obtained through staining of levator aponeurosis complexes using Hematoxylin and Eosin and Masson’s trichrome.

Results

In this prospective study, 29 patients showed a significant increase in mean MRD-1 from 2.56 ± 0.84 mm (range 1.02–3.98 mm) preoperatively to 4.38 ± 0.55 mm (range 3.09–5.35 mm) at the 12-month follow-up (paired t-test; P < 0.001). Masson’s staining revealed that the levator aponeurosis tissue primarily consists of collagen fibers, which minimize potential errors due to their toughness and lack of elasticity during the surgical procedure.

Conclusions

The modified technique enhances the accuracy of levator aponeurosis advancement in ptosis correction, resulting in minimal surgical trauma and high patient satisfaction. Our technique appears to have a low incidence of severe adverse effects, based on the available data from the current case series.

Level of Evidence IV

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