Chapter 154 Tarsal Switch Levator Resection for the Treatment of Myopathic Blepharoptosis 489

Figure 154.6. Preoperative photo; had to lift chin to see.

Figure 154.7. Twelve-month postoperative photo, chin normal.

Suggested Reading

DeMartelaere SL, Blaydon SM, Shore JW. Tarsal switch levator resection for the treatment of blepharoptosis in patients with poor eye protective mechanims. Ophthalmology 2006;113:2357–2363.

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Modified Levator Advancement

Ptosis Technique

Rona Z. Silkiss

A preferred technique for the repair of ptosis is a modification of a levator advancement technique.

In this modified technique, a blepharoplasty is performed if needed, after which the levator aponeurosisis reflected from its insertion from underlying tarsus and Müller’s muscle. Two or three double-armed 5–0 Dexon sutures on a SS2 spatulated half-circle needle are then placed in a lamellar fashion through tarsus. These sutures are placed in the midline as well as medially and occasionally laterally. There is a “sweet spot” just medial to the midline that provides for an optimal eyelid configuration. These sutures are then placed in a mattress fashion through the levator aponeurosis superior to the area of relative thinning. All the double-armed sutures are then held with a snap and tied and cut.

The advanced aponeurosis may or may not be trimmed. The skin is then closed in the usual fashion.

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