Four-Step Levator Aponeurosis Plication Technique for Mild-Moderate Congenital Blepharoptosis

The levator aponeurosis plication technique has shown successful functional and cosmetic results for mild blepharoptosis. However, for moderate ptosis, the plication technique has to face some functional and cosmetic challenges, such as insufficient correction, poor eyelid closure function, deep-set double-eyelid crease, and obvious depressed scar. How to expand its application range from mild to moderate ptosis and achieve satisfactory results is a topic worth considering. To solve this problem, our team have made modifications to the levator aponeurosis plication technique. In this article, the authors shared their experience of using the 4-step levator aponeurosis plication technique in mild to moderate blepharoptosis and evaluated the postoperative results.

A retrospective study of all patients who underwent the 4-step levator aponeurosis plication to correct mild-moderate congenital blepharoptosis was performed from May 2022 to December 2023.

In total, 76 patients (117 eyes) had mild ptosis, and 56 patients (88 eyes) had moderate ptosis. Postoperatively, both groups showed significant improvement in MRD1 after surgery compared with preoperative MRD1. There was no significant difference between the mild and moderate groups in terms of postoperative MRD1, successful correction rate, and satisfaction rate. Complications such as infection, hematoma, corneal abrasion, keratitis, eyelid foreign body sensation, suture exposure, and residual lagophthalmos were not found in any cases during follow-up.

The 4-step levator aponeurosis plication technique introduced in this study is equally effective for mild and moderate congenital blepharoptosis in obtaining sufficient corrective results and satisfactory cosmetic results, and minimizing residual lagophthalmos and depressed scar.

Level IV.