Abstract
Purpose: Even in a small levator resection for blepharoptosis, 10 ~ 13 mm of $M{\ddot{u}}ller^{\prime}s$ muscle and levator aponeurosis is resected. To solve the problem, $M{\ddot{u}}ller^{\prime}s$ muscle was detached from the superior tarsal border and conjunctiva, and the muscle with overlying levator aponeurosis was advanced on the upper tarsus as a composite flap. The purpose of this study was to evaluate the effectiveness of the $M{\ddot{u}}ller^{\prime}s$ muscle - levator aponeurosis complex advancement technique for the correction of blepharoptosis. Methods: Between 2003 and 2008, 107 patients(183 eyes) underwent the advancement procedure of the $M{\ddot{u}}ller^{\prime}s$ muscle - levator aponeurosis composite flap for blepharoptosis. The advanced composite flap was fixed 3 mm below the superior tarsal border and 2 ~ 3 mm of distal flap stump was left after trimming up to 5 mm. The results of the operations were evaluated. Results: The mean age of the patients was 35.2 years and 83 patients(145 eyes) were followed up for a mean of 16.7 months. 128 eyes (88.3%) showed a normal level of upper eyelid margin (MRD1 4.1 ~ 5.0 mm) or less than 1 mm ptosis (MRD1 3.1 ~ 4.0 mm). 10 eyes(6.9%) showed 1 ~ 2 mm ptosis (MRD1 2.1 ~ 3.0 mm). 7 eyes(4.8%) showed more than 2 mm ptosis which required secondary correction. About 80% of the 183 eyes needed no trimming of the flap stump with 5 ~ 6 mm of composite flap advancement and 20% had about 3 mm of the flap stump trimmed with 8 ~ 9 mm of composite flap advancement(shortening of the levator complex). Conclusion: $M{\ddot{u}}ller^{\prime}s$ muscle - levator aponeurosis complex advancement technique offers several advantages: There is no, or minimal, sacrifice of the normally functioning $M{\ddot{u}}ller^{\prime}s$ muscle; it is more physiological; it is reproducible and it is predictable - with gratifying results for blepharoptosis.