Transposition of the levator in blepharoptosis using a single superior lid crease incision

In 1999 we introduced the technique of transposition of the levator using a suture to the frontalis muscle for the correction of severe blepharoptosis [16, 17]. This operation was carried out using two skin incisions, one on the superior lid crease and the other at the superior margin of the eyebrow. It was later demonstrated that the levator muscle becomes reinnervated by the facial nerve branches to the frontalis muscle [18]. The results of this procedure have been satisfactory without infections or lagophthalmos [9, 19, 20]. The only limit of this technique is the ability of the patient to contract the frontalis muscle. This limitation, however, applies to any surgical technique which consists of suspension of the eyelid to the frontalis area. After having performed 22 levator transpositions, utilizing two skin incisions, the procedure is now performed with a single skin incision on the superior lid crease. With this modification the technique might be well accepted by those surgeons who deal with the problems of upper eyelid ptosis.