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.

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Keywords: Levator aponeurosis advancement; Ptosis correction; Upper eyelid ptosis.