Practical ptosis surgery. The Wendell L. Hughes Lecture

The author has emphasized the concept that ptosis surgery should be done in a way that may be modified in the event that the immediate result is not satisfactory. The value of local injection plus fractional anesthesia in the adult allows the surgeon to solicit the aid of the patient to evaluate the result on the table more accurately. A regional block is unsatisfactory because the nerve supply to the levator muscle may be knocked out and titration of the result would not be possible at the time of surgery. The subaponeurotic tunnel without incising the conjunctiva makes a better anatomic dissection of the aponeurosis. The attachment to the tarsus of the advanced aponeurosis 2 to 3 mm from the ciliary border gives the surgeon a leeway of approximately 7 to 8 mm to recess in the event of an overcorrection. In the event of an undercorrection, the aponeurosis is further advanced and reattached by the three vertical mattress sutures.