Adjunctive techniques to traditional advancement procedures for treating severe blepharoptosis

Area of Science:

• Ophthalmology
• Oculoplastic Surgery

Background:

• Severe blepharoptosis management requires techniques for physiologic eyelid opening.
• Traditional methods may not fully restore eyelid function.
• Composite flaps offer a novel approach to address complex ptosis cases.

Purpose of the Study:

• To evaluate the efficacy of a novel composite flap advancement technique for severe blepharoptosis.
• To assess the functional and aesthetic outcomes of this surgical approach.
• To determine the complication rates associated with the procedure.

Main Methods:

• A composite flap of levator aponeurosis, Müller's muscle, and conjunctival lamina propria mucosa was used in 50 patients (85 eyelids) with severe blepharoptosis (>4 mm).
• Epicanthoplasty with medial canthal tendon shortening was performed in 21 patients with epicanthal folds and telecanthus.
• Preoperative and postoperative measurements of ptosis degree and levator function were recorded.

Main Results:

• Complete or near-complete ptosis correction (<1 mm) was achieved in 63.5% of eyelids.
• Mild residual ptosis (1-2 mm) was observed in 25.9% of eyelids at 6-month follow-up.
• The most frequent complication was reoperation (17.6%) due to incomplete correction.

Conclusions:

• The composite flap advancement technique is effective for severe blepharoptosis with moderate levator function (2-7 mm).
• The technique promotes superior-posterior eyelid elevation, creating a physiologic eyelid opening.
• No serious complications like long-term lagophthalmos or lid lag were reported.