Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery

We describe a surgical technique for ptosis correction in moderate to good levator function involving advancement of the levator aponeurosis via a transconjunctival posterior approach without resection of Müller's muscle. We present our experience of and the results from this method, and review the evolution of posterior approach ptosis surgery.

To assess the efficacy and predictability of posterior approach white line advancement ptosis repair.

Retrospective analysis of all patients with primary aponeurotic ptosis undergoing posterior-approach repair using white line advancement between December 2007 and June 2008. We describe a technique whereby after dissection of the Muller's conjunctiva composite flap, the levator aponeurosis is advanced with double-armed sutures through the white line, then through the tarsus and out through the skin.

There were 112 ptosis procedures during this period, of which 71 eyelids of 41 patients were eligible for inclusion. There were 14 men and 27 women. The mean age was 63.76 (range 24-87) years. Minimum follow up was 3 months (range 12-43 weeks). Of the 71 procedures, 42 were combined with a blepharoplasty. Sixty-two achieved their desired lid height, contour and symmetry (87.3% success rate). No patients were overcorrected. Success rate in the phenylephrine-positive group (42/71) was 88.1% compared with 100% in phenylephrine-negative group (4/71).

We present a modified approach to ptosis correction via a posterior approach. It has a high success rate and good cosmetic outcome. It is technically straightforward and easy to learn.