title: A modified technique combining excision of the levator muscle and tarsus for blepharoptosis in Asians: a 6-year experience with 116 cases.
abstract: BACKGROUND
  In patients with blepharoptosis, the function of levator muscle is insufficient or completely absent, causing blepharoptosis in various degrees. For mild or moderate blepharoptosis, levator advancement or resection is commonly performed. However, in severe cases, undercorrection results and recurrence often occur even a great length of levator muscle is resected. Because the levator muscle makes the upper eyelid move in a physiologic direction, exerting the function of residual levator muscle is still a more preferred approach for correction of blepharoptosis. This study combined tarsus resection with levator resection. The resected tarsus can offset the amount of the levator excised, making this technique applicable for severe cases.
  
  
  METHODS
  This study included 116 patients (175 eyelids) with moderate or severe ptosis who underwent combined excision of the levator muscle and the tarsus. For cases of bilateral blepharoptosis with different levator functions between the two eyelids, surgery was performed for more severe side first and for the other side 6 months later. Postoperatively, the correction and symmetry results were evaluated and analyzed using chi-square testing by SPSS (version 10.0).
  
  
  RESULTS
  Adequate or normal correction was achieved in 149 eyelids (85.1%). The difference in correction results did not differ significantly between moderate and severe cases. With a two-stage operation, 98 patients (84.5%) obtained good or fair asymmetry results, and no statistically significant difference existed between the bilateral and unilateral cases.
  
  
  CONCLUSIONS
  The described technique appears to be effective for both moderate and severe ptosis, with better biomechanics and a satisfying aesthetic outcome.
authors.affiliation: Department of Plastic and Reconstructive Surgery, The Ninth People's Hospital affiliated to Shanghai Jiaotong University, 639 Zhi Zao Ju Road, 200011, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
authors.forename: Feng
authors.initials: F
authors.lastname: Yang
authors.forename: Xu-Song
authors.initials: XS
authors.lastname: Luo
authors.forename: Jia-Sheng
authors.initials: JS
authors.lastname: Dong
authors.forename: Bianca
authors.initials: B
authors.lastname: Chin
authors.forename: Jun
authors.initials: J
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D002648:Child; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery*; D055815:Young Adult