Borderline to Moderate Blepharoptosis Correction Using Retrotarsal Tucking of Müller Muscle: Levator Aponeurosis in Asian Eyelids

Abstract

Background

The purpose of this paper is to report the outcome of retrotarsal tucking of Müller muscle-levator aponeurosis for the correction of borderline to moderate ptosis in conjunction with esthetic blepharoplasty in Asian eyelids and to explore the relationship between the extent of advancement and change in the eyelid position (MRD₁).

Methods

The medical records of 290 consecutive patients who underwent retrotarsal tucking of Müller muscle-levator aponeurosis from February 2005 to November 2011 were reviewed. Of those, 26 patients (51 eyelids) were statistically analyzed. The correction was performed through an external upper blepharoplasty approach. Once the orbital septum was opened, the Müller muscle-levator aponeurosis was advanced and tucked under the posterior surface of the tarsus by a single lifting suture. The average follow-up period was 20.6 months, with a range of 3–68 months.

Results

In 26 patients (51 eyelids), satisfactory results were recorded for 49 of 51 eyelids (96.1 %). The margin reflex distance-1 (MRD₁) increased from 1.56 ± 0.70 mm preoperatively to 3.86 ± 0.94 mm postoperatively (p < 0.001, Wilcoxon signed rank test). When 6.1 mm of advancement was implemented, an average MRD₁ of 1 mm was achieved. For 7.2 and 8.3 mm of advancement, the average MRD₁ achieved was 2 and 3 mm each. A noteworthy complication, although not included in statistical analysis, was one patient who had developed corneal irritation caused by the conjunctival exposure to the non-absorbable suture 3 years after the surgery, which led the subject to have the suture removed.

Conclusion

The author concludes that this procedure is one of the most effective surgical options in correcting borderline to moderate blepharoptosis in conjunction with esthetic blepharoplasty. The main advantage of such a method is that once the orbital septum is opened, Müller muscle-levator aponeurosis is easily advanced and tucked under the posterior surface of the tarsal plate without extensive dissection or resection, which is less traumatic and gives a more vertical lifting vector, thus producing excellent cosmetic results and quick recovery.

Level of Evidence V

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