title: Enhanced Fasanella-Servat Procedure for the Graded Repair of Blepharoptosis.
abstract: OBJECTIVE
  To describe in detail a technique for a modified Fasanella-Servat procedure that provides a simplified method for graded Mueller muscle excision with minimal and controlled tarsal excision.
  
  
  METHODS
  A retrospective study of 71 patients (102 eyelids) who underwent the modified Fasanella-Servat procedure is reported. Measurements include the preoperative, post-phenylephrine, and postoperative margin-to-reflex distance-1, and postoperative upper eyelid height symmetry as determined by the absolute difference between right- and left-sided margin-to-reflex distance-1. Postoperative complications are reported.
  
  
  RESULTS
  The average increase in margin-to-reflex distance-1 was 2.4 mm with an average postoperative upper eyelid height symmetry of 0.4 mm. Postoperative asymmetry was 1.5 mm or less in 68 patients, a success rate of 96%. Four patients (6%) exhibited overcorrection, 2 of which required additional surgery. No lagophthalmos or notable eyelid contour abnormalities were seen.
  
  
  CONCLUSIONS
  The modified Fasanella-Servat technique offers a simple method to isolate and resect Mueller muscle and a minimal segment of tarsus in a quantitative fashion, allowing for a graded repair of blepharoptosis and thereby decreasing the risk of postoperative overcorrection, lagophthalmos, and eyelid contour asymmetry whilst preserving the bulk of tarsus.
authors.affiliation: *Ophthalmic Plastic and Reconstructive, and Orbital Surgery Division, Department of Ophthalmology, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, U.S.A.; and †Ocular Plastics Unit, Department of Ophthalmology, Prince of Wales Hospital, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: North
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Campbell
authors.forename: Alison B
authors.initials: AB
authors.lastname: Callahan
authors.forename: Geoff
authors.initials: G
authors.lastname: Wilcsek
authors.forename: Michael
authors.initials: M
authors.lastname: Kazim
mesh_terms: D000368:Aged; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000601:surgery*; D005143:Eyelids / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D012189:Retrospective Studies; D013536:Suture Techniques