Aesthetic Correction of Mild-to-Moderate Blepharoptosis Among Asians: The Bridge Technique

Although several surgical methods have been introduced to treat mild-to-moderate blepharoptosis, including levator-based techniques such as Müller muscle-conjunctival resection, few complications and better functional and aesthetic outcomes remain elusive for plastic surgeons. Hence, this study aimed to provide a new technique (bridge technique) using the levator aponeurosis-Müller's muscle flap to achieve optimal blepharoptosis correction for function and aesthetics among Asians.

From January 2019 to May 2020, this new technique was performed on 157 consecutive patients with mild-to-moderate blepharoptosis. Our technique was based on the anchor of the levator complex to the tarsus using mattress stitches and three-layer fixation, which provided a reliable motion transmitter for elevating the upper eyelid. The patients' medical records and photographs were reviewed 12 months postoperatively to assess the margin reflex distance 1 (MRD1), incidence of complications, and aesthetic outcomes.

The average preoperative and postoperative MRD1 measured 1.2 ± 0.31 mm and 3.7 ± 0.34 mm, respectively. A significant difference was observed between the preoperative and postoperative distance values (p < 0.001). In the aesthetic evaluation, the grading was good, fair, and poor for 142 (90.4%) patients, 10 (6.4%) patients, and 5 (3.2%) patients, respectively. Complications included undercorrection in 12 (5.2%) cases and overcorrection in nine (3.9%) cases, and no cases of residual lagophthalmos were recorded.

Mild-to-moderate blepharoptosis among Asians can be corrected effectively using this new technique. However, the long-term outcomes of this procedure should be explored.