title: A Modified Levator Resection Technique Involving Retention of the Levator Palpebrae Superioris Muscle Suspension System for Treatment of Congenital Ptosis.
abstract: BACKGROUND
  The classical levator resection (LR) technique for correcting ptosis involves separating the levator palpebrae superioris muscle (LPS) completely, which will inevitably collapse the muscle. The modified surgical method involving retention of the LPS suspensory system can allow for more contractility of the levator muscle and thus maximize protection of the eyelid structure.
  
  
  METHODS
  Ninety patients (132 eyelids) with different degrees of ptosis were enrolled. The same levator resection surgery whereby the suspensory system of the LPS is retained was performed in each patient. Postoperative outcome measures included the following: position of the upper eyelid margin, eyelid contour and plumpness, degree of scleral exposure, and exposure keratitis. Postoperative follow-up time points were 1 week, 1 month, and 6 months.
  
  
  RESULTS
  The positions of the eyelid upper margins were normal in all cases, and lagophthalmos only existed in severe cases in the early stage after surgery. Six months after surgery, 32% of the eyes had residual ptosis to varying degrees among severe cases, and the mild and moderate cases exhibited good surgical outcomes. The eyelids had appropriate closing functionality, and exposure keratitis was not observed in any case. Eyelid contour and plumpness was satisfactory in all patients.
  
  
  CONCLUSIONS
  Retaining the suspensory system of the LPS for LR with a modified surgery can protect the normal function and morphology of the eyelids. The surgery had a high success rate, especially for cases of mild and moderate ptosis.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Ophthalmology, Second Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Zuo
authors.affiliation: Department of Ophthalmology, Second Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Xing X
authors.initials: XX
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Second Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Xin Y
authors.initials: XY
authors.lastname: Huang
authors.affiliation: Department of Ophthalmology, Second Hospital of Jilin University, Changchun, Jilin, China.
authors.forename: Jia L
authors.initials: JL
authors.lastname: Zhang
authors.affiliation: Mylike Medical Cosmetic Hospital, Mylike Tower, 789 West Yan'an Road, Changning District, Shanghai, China. 18686623812@163.com.
authors.forename: Yuan Y
authors.identifier: http://orcid.org/0000-0003-1925-7263
authors.initials: YY
authors.lastname: Du
mesh_terms: D000293:Adolescent; D019882:Blepharoplasty / Q000379:methods*; D001763:Blepharoptosis / Q000151:congenital* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D004954:Esthetics; D005143:Eyelids / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D059351:Organ Sparing Treatments; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Levator aponeurosis–Müller’s muscle composite flap; Levator resection; Ptosis; Suspensory system