Conjoint Fascial Sheath Suspension for Correction of Severe Involutional Blepharoptosis

Involutional ptosis is considered to be the result of the disinsertion of the levator aponeurosis from the tarsal plate. However, present histopathological studies indicate that the pathogenesis of involutional ptosis is multifactorial and complex. To create a more physiologic eyelid opening in patients with severe involutional blepharoptosis, the authors used conjoint fascial sheath (CFS) as suspension location. Sixty-seven involutional blepharoptosis patients (123 eyelids) with a degree of severe ptosis (marginal reflex distance 1, MRD-1 <1.0 mm) underwent the CFS suspension. The primary outcome was MRD-1 at 12 months after surgery. Secondary outcomes were cosmetic outcomes and postoperative complications. All the eyelids had fair MRD-1 (MRD-1≥2.0 mm) at 12 months. Complete correction of ptosis (MRD-1≥2.5 mm) at 12 months was obtained in 80 eyelids (65%). There were no overcorrections. The mean cosmetic outcome by patients was 3.56 ± 0.61 at 12 months. The most common complication was reoperation, which was done in 9 eyelids (7%) because of incomplete correction. CFS suspension was effective in the treatment of severe involutional blepharoptosis. The technique produced an elevating motion of the physiologic eyelid in a superior-posterior direction.