Internal levator advancement by Müller's muscle-conjunctival resection: technique and review

Müller's muscle-conjunctival resection surgery presumably works by advancing the levator aponeurosis of the upper eyelid. The amount of blepharoptosis and the lid's response to the instillation of phenylephrine hydrochloride onto the superior ocular fornix are used to determine the extent of surgery needed.

To demonstrate the procedure developed and popularized by Allen M. Putterman, MD, performed by Michael Mercandetti, MD, MBA, and to describe the relationship between the amount of Müller's muscle-conjunctival resection performed and the amount of elevation achieved.

Data were retrospectively analyzed based on surgical cases done over a 5-year period by one surgeon (A.M.P.).

A linear regression model was developed. From this regression a simple table correlating the amount of resection with the amount of elevation desired was derived.

The surgeon will need to modify the table based on his or her clinical experience and postoperative results.