title: Comparison of Blepharoptosis Correction Using Müller-aponeurosis Composite Flap Advancement and Frontalis Muscle Transfer.
abstract: BACKGROUND
  Treatments for severe blepharoptosis are well documented and include the most common operations for restoring upper eyelid ptosis, which are levator surgery and frontal muscle transfers; however, the choice of treatment is still controversial. There are different approaches to the restoration of upper eyelid ptosis, and the choice will be based on ptosis severity and the surgeon's skill and experience.
  
  
  METHODS
  Two hundred and fourteen patients presenting with a levator function of between 2 and 4 mm received ptosis correction between 1991 and 2010 at our clinic. Of these, 71 patients underwent Müller aponeurosis composite flap advancement for correction of 89 eyelids, and frontalis muscle transfer was performed on 143 patients (217 eyelids). Postoperative results were evaluated with an average follow-up period of 23 months.
  
  
  RESULTS
  The preoperative average for marginal reflex distance (MRD1) in the Müller aponeurosis composite flap advancement group was 1.25 mm, and in the frontal muscle transfer group, it was 0.59 mm. The area of corneal exposure (ACE) was 57.2% in the Müller aponeurosis composite flap advancement group and 53.6% in the frontal muscle transfer group. The postoperative average distance was not significantly different for the 2 techniques. In the Müller aponeurosis composite flap advancement group, MRD1 was 2.7 mm and ACE was improved to 73.5%. In the frontal muscle transfer group, MRD1 was 2.3 mm and ACE was 71.2%. Undercorrection and eyelid asymmetry were the most frequently observed postoperative complications for both techniques.
  
  
  CONCLUSIONS
  In our study, we confirmed that Müller aponeurosis composite flap advancement and the frontalis transfer technique are both effective in the correction of severe blepharoptosis; our results showed no significant differences between the 2 techniques.
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: David Dae Hawan
authors.initials: DD
authors.lastname: Park
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Anwar
authors.initials: A
authors.lastname: Ramadhan
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Dong Gil
authors.initials: DG
authors.lastname: Han
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Jeong Su
authors.initials: JS
authors.lastname: Shim
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Yong Jig
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Won Ho
authors.initials: WH
authors.lastname: Ha
authors.affiliation: Department of Medicine, Catholic University of Daegu, Daegu, Korea; and Amiri Hospital, Kuwait City, Kuwait.
authors.forename: Byung Kwon
authors.initials: BK
authors.lastname: Lee