Transblepharoplasty ptosis repair: three-step technique.

Background: The ability to predict postoperative lid levels in ptosis surgery has been refined over the years, but there is no completely predictable formula with which to predict the final tension in the upper lid that determines the final upper lid level. A significant percentage of patients continue to require postoperative surgical revision. The authors studied the effectiveness of a technique for the quantitation of aponeurotic repair that is not a measured resection procedure, does not require voluntary patient cooperation, and can be performed under general anesthesia. Methods: The surgical technique involves reapproximation of specific anatomical landmarks, adjustment of upper lid level by eyelid gapping, and adjustment of upper lid tension with a spring-back test. Consecutive patient charts were reviewed retrospectively for age, sex, clinical examination, levator function, and outcomes, including revision rate and patient satisfaction. A total of 144 procedures were performed for 80 patients (64 bilateral and 16 unilateral). The series was reported for a 3-year period (2002 through 2005). The mean age was 62 years (range, 40 to 85 years). The average follow-up was 18 months. All patients had acquired adult ptosis with levator dehiscence and good levator function. Results: The criterion for surgical revision was a greater than 1-mm asymmetry between the eyelids or patient dissatisfaction. Twelve patients (15 percent) were considered to be slightly asymmetric postoperatively, but only two (2.5 percent) exceeded the criterion and required surgical revision in the early postoperative period (<1 year). Conclusion: Tarso levator surgery can be performed under general anesthesia using a three-step technique to correct ptosis with a superior predictability.