Early revision in the office for adults after unsatisfactory blepharoptosis correction

The most common complications of levator palpebrae superioris muscle blepharoptosis repair are undercorrection, overcorrection, and abnormalities of the eyelid contour. Previously described nonsurgical as well as surgical methods delay the repair of such complications and introduce the same confounding factors that can affect judgment of the eyelid level as during the initial surgical procedure. Twenty-two patients underwent a highly predictable surgical technique to revise unsatisfactory postoperative eyelid positions. Twenty-five of 26 eyelids (96%) had a satisfactory result and only one of 26 (4%) remained undercorrected. The revision is performed three to four days after the initial blepharoptosis correction and involves blunt separation of the wound without local anesthesia. The levator aponeurosis is advanced or recessed and resutured to the tarsus to achieve the proper eyelid height and contour. The advantages of this revision technique are as follows: (1) the procedure can be quickly and easily performed in the office; (2) the anatomic defects are corrected; (3) sharp dissection, bleeding, and edema are avoided; (4) the technique is painless and usually requires no local anesthetic injections; (5) the tone and function of the levator palpebrae superioris muscle, Müller's, and orbicularis oculi muscles remain undisturbed intraoperatively; and (6) early correction is achieved, thereby enhancing patient acceptance.