Transconjunctival levator aponeurotic repair without resection of Müller's muscle

The number of patients with acquired ptosis is on the rise, and correction of blepharoptosis without any postsurgical scars on the eyelid is desired by most. Despite the advantages of the transconjunctival approach for blepharoptosis surgery, its use has been diminishing. The authors performed transconjunctival levator aponeurotic surgery without resecting Müller's muscle for 21 eyelids in 14 patients with blepharoptosis. In 13 of these patients, 20 eyelids were successfully corrected. No major complications such as entropion, eyelid lag, or persistent irritation of the eye were observed. One eyelid with severe blepharoptosis showed an undercorrection of 1.5 mm. Aesthetic "double eyelid" with symmetric folds was achieved for all but one patient. The advantage is that without a skin incision, the reported method requires less downtime, leaves no conspicuous scar on the eyelid, and meets with marked satisfaction by most patients. It is beneficial for candidates who desire no skin incision but have indications for levator aponeurotic surgery and do not present with excessive upper eyelid laxity. This approach presents some challenges, however. One of these involves determining the degree of aponeurosis advancement according to the degree of the open eye during surgery and creating the desired "double-eyelid" shape and size, especially in Asians. Also, the surgeon needs to gain familiarity with the surgical anatomy of the everted eyelid. This method could, with refinements, become the procedure of choice for the correction of blepharoptosis in selected patients.