Fig. 22.1 Illustration of the theory behind full-thickness eyelid resection. If the desired amount of blepharoptosis correction is excised from the lid margin, an accurate and predictable amount of correction would be achieved. Reprinted with permission from Henry Baylis, MD

trouser leg. The trousers would then be the perfect length. Similarly, if an upper eyelid is 3 mm too low, resecting 3 mm of full-thickness eyelid from the margin would solve the length problem (Fig. 22.1). Of course, this is impractical because critical eyelid margin structures, such as lashes, blood vessels, and meibomian glands, need to be preserved for proper ocular surface function. We recommend sparing the inferior 4 mm of upper eyelid but performing full-thickness resection within the area superior to this demarcation and inferior to the level of the orbital septum (Fig. 22.2). In this area, tissue planes are less fluid, especially in multioperated scarred eyelids. Full-thickness eyelid resection in these cases can achieve a predictable amount of blepharoptosis correction. Additionally, eyelid margin contour abnormalities can be resolved reliably.

Two techniques for this surgery were previously published. In 1977, Baylis and Shorr described the lamellar dissection method and Baylis et al. subsequently described the en bloc dissection method [6, 7]. Both techniques are described in detail below.

Fig. 22.2 Cross-section of normal upper eyelid. The dotted lines demarcate the segment of tissue recommended for full-thickness eyelid resection. The inferior incision should spare at least 4 mm of tissue at the eyelid margin. The superior incision should not be so high as to breach the orbital septum. Reprinted with permission from Henry Baylis, MD

Indications

Although full-thickness eyelid resection by either technique may be performed with satisfactory results in primary correction of blepharoptosis, we find ourselves utilizing full-thickness eyelid resection most frequently for especially challenging cases of secondary blepharoptosis repair. The underlying etiologies of the ptosis and procedures, which had been used for the primary repair, are irrelevant. Full-thickness eyelid resection has long been used successfully for secondary correction of residual upper eyelid blepharoptosis due to congenital, neurogenic, and myogenic causes. In congenital blepharoptosis, the levator muscle is relatively less distensible or nondistensible. Therefore, full-thickness blepharoptosis surgery is more predictable and efficacious.