title: Adjunctive techniques to traditional advancement procedures for treating severe blepharoptosis.
abstract: BACKGROUND
  To create a more physiologic eyelid opening in patients with severe blepharoptosis, the authors used lamina propria mucosa of conjunctiva, which continues to the check ligament of the superior fornix, in addition to levator aponeurosis and Müller's muscle as a composite flap. In patients with epicanthal folds with associated telecanthus, the authors also performed epicanthoplasty with medial canthal tendon shortening.
  
  
  METHODS
  Fifty blepharoptosis patients (85 eyelids) with a degree of ptosis of greater than 4 mm underwent the advancement technique using the levator aponeurosis-Müller's muscle-lamina propria mucosa of conjunctiva as a composite flap. Twenty-one (42 percent) of those patients also underwent split V-W epicanthoplasty and plication of the medial canthal tendon for epicanthal folds with associated telecanthus. Degree of ptosis and levator function were measured preoperatively and postoperatively.
  
  
  RESULTS
  Complete or near-complete correction of ptosis (degree of ptosis, <1 mm) was achieved in 54 eyelids (63.5 percent) and mild residual ptosis (degree of ptosis, 1 to 2 mm) was observed in 22 eyelids (25.9 percent) in postoperative follow-up after 6 months. The most common complication was reoperation, which was done in 15 eyelids (17.6 percent) because of incomplete correction.
  
  
  CONCLUSIONS
  The advancement technique using the levator aponeurosis- Müller's muscle-lamina propria mucosa of conjunctiva composite was effective in the treatment of severe blepharoptosis with levator function of 2 to 7 mm. The technique produced elevating motion of the physiologic eyelid in a superior-posterior direction. There were no serious complications, such as long-term lagophthalmos or lid lag.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Ulsan, South Korea; and Los Angeles, Calif. From the Department of Plastic and Reconstructive Surgery, Dong Kang General Hospital; Dream Medical Group; and the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of California, Los Angeles.
authors.forename: Bong Soo
authors.initials: BS
authors.lastname: Baik
authors.forename: Won
authors.initials: W
authors.lastname: Ha
authors.forename: Ji Won
authors.initials: JW
authors.lastname: Lee
authors.forename: So Young
authors.initials: SY
authors.lastname: Ji
authors.forename: Wan Suk
authors.initials: WS
authors.lastname: Yang
authors.forename: DaEun
authors.initials: D
authors.lastname: Park
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000208:ethnology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D055815:Young Adult