title: The current state of ptosis repair: a comparison of internal and external approaches.
abstract: OBJECTIVE
  Posterior approach ptosis repair has made a resurgence over the last decade. The purpose of this review is to examine the history of posterior approach ptosis repair and the events that have led to its current favorable status.
  
  
  RESULTS
  The evolution of the posterior and anterior approach ptosis surgeries has resulted in two favored techniques for involutional ptosis repair: the Müller muscle-conjunctiva resection (MMCR) and the external levator advancement. Each procedure has strong and prominent proponents in the oculoplastic surgery community. Recently, the MMCR has converted surgeons who have previously favored the external levator advancement. A number of factors have influenced this recent elevation of the MMCR including differing opinions on the cause of involutional ptosis, the mechanism by which the MMCR works, the predictability and speed of the MMCR, and the current reimbursements for ptosis repair by insurance companies.
  
  
  CONCLUSIONS
  The recent preference for posterior approach ptosis surgery, in particular the MMCR, is multifactorial. In order to understand the evolution of opinions about the procedure, a historical knowledge of involutional ptosis and ptosis repair is necessary.
authors: Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. Richard-Allen@uiowa.edu
authors: Richard C
authors: RC
authors: Allen
authors: Meredith A
authors: MA
authors: Saylor
authors: Jeffrey A
authors: JA
authors: Nerad
mesh_terms: D019882:Blepharoplasty / Q000379:methods* / Q000639:trends; D001763:Blepharoptosis / Q000601:surgery*; D003228:Conjunctiva / Q000601:surgery*; D004954:Esthetics; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D016896:Treatment Outcome