Standardized Suture Placement for Mini-invasive Ptosis Surgery

Ahuero, Audrey E.; Winn, Bryan J.; Sires, Bryan S.

doi:10.1001/archfacial.2012.388

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…Lucarelli and Lemke 13 pioneered the small-incision technique to limit incision size. Ahuero and colleagues 14 added to the small-incision technique by marking the site for suture placement preoperatively. In this study, we build on these principles, validating modifications of Martin's algorithm 12 that account for the extensile nature of the levator aponeurosis.…”

mentioning

confidence: 99%

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Repp¹,

Rubinstein²,

Sires³

2017

JAMA Facial Plast Surg

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IMPORTANCE External surgical treatment of involutional ptosis with normal levator function is challenging owing to lack of an established algorithm. Developing an algorithm-based technique could improve postoperative results while limiting intraoperative inefficiencies. OBJECTIVE To investigate the postoperative success of an algorithmic external levator aponeurosis resection technique for aponeurotic ptosis with good levator function. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with involutional ptosis and normal levator function who were treated from July 1, 2015, through November 30, 2016, at a private ophthalmic plastic surgery clinic. INTERVENTIONSThe technique involved a small incision in the eyelid crease, with dissection through the orbital septum to expose the levator aponeurosis. The leading edge of the aponeurosis was then clamped to a medical-grade spring scale to standardize the stress on the eyelid between patients. Two millimeters of aponeurosis were resected for every 1 mm of desired ptosis correction. Two sutures were then placed to connect the aponeurosis to the tarsus at predetermined locations. MAIN OUTCOMES AND MEASURES Preoperative predicted (goal) vs actual margin reflex distance-1 (MRD1).RESULTS Twenty-six eyelids of 15 patients (6 men and 9 women; mean [SD] age, 65 years [range, 17-84 years]) met inclusion criteria. The mean follow-up was 189 days (range, 63-343 days). The mean preoperative MRD1 was 0.44 mm (range, −0.5 to 2 mm; 95% CI, 0.18-0.70 mm) compared with the final mean MRD1 of 3.2 mm (range, 2.5-4.0 mm; 95% CI, 3.1-3.4 mm; P < .001). The mean predicted goal MRD1 was 3.4 mm (range, 2.5-4.0 mm; 95% CI, 3.2-3.5 mm). The final MRD1 of all eyelids was within 1 mm of the goal MRD1. The mean surgical time per eyelid was 14.6 minutes (range, 10.5-34.0 minutes). Twelve eyelids (46%) did not have intraoperative suture adjustments. CONCLUSIONS AND RELEVANCEIn correcting aponeurotic ptosis, a small-incision levator aponeurectomy incorporating an algorithm and consistent stress on the aponeurosis during resection achieves the goal MRD1 efficiently. The algorithm closely estimates the desired height intraoperatively such that only small intraoperative suture height revisions, if any, are needed. No intraoperative adjustments were made in 12 eyelids, necessitating future studies to determine whether any adjustments are needed.LEVEL OF EVIDENCE 3.

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mentioning

confidence: 99%

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Repp¹,

Rubinstein²,

Sires³

2017

JAMA Facial Plast Surg

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“…is is much shorter when compared to the earlier reported durations using either external or transconjunctival approaches [19].…”

Section: Discussionmentioning

confidence: 56%

“…For the authors, the mean operating time to complete one eyelid was 15 ± 5 min, when not combined with any other procedures. This is much shorter when compared to the earlier reported durations using either external or transconjunctival approaches [ 19 ].…”

Section: Discussionmentioning

confidence: 67%

Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique

Habroosh

Eatamadi

2020

Journal of Ophthalmology

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Purpose. To describe a modified technique of white line advancement posterior ptosis surgery and to report the success rate of the procedure. Methods. A retrospective case series of 60 patients who presented with ptosis with good levator function. The success rate was defined as an MRD1 of greater than or equal to 3.5 mm, symmetrical eyelid position with an intereyelid height asymmetry of ≤1 mm, and a satisfactory eyelid contour at 3 months follow-up. Results. Sixty patients (91 eyelids) met the inclusion criteria. Mild postoperative complications occurred in 11 patients that resolved without surgical intervention. Seven patients had recurrence of ptosis: four patients had early recurrence and 3 had late recurrence. The success rate was 88.33% with an average follow-up of 9 months. Conclusion. This procedure is a promising technique in cosmetic and functional ptosis correction. The advantage of this posterior approach procedure is that there is no conjunctival resection; it is suitable for young patients who do not have excess eyelid skin. The procedure is quick with a short recovery period. Additionally, it can be combined with another procedure and in different pathology.

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“…Meltzer et al [8] presented their experience using an adjustable suture. Later, Ahuero et al [9] proposed a refinement to small-incision surgery with a standardized suture placement at the medial pupillary border and lateral limbus.…”

Section: Discussionmentioning

confidence: 99%

“…This approach can be cumbersome and require multiple adjustments intraoperatively to achieve proper contour. There have been several studies suggesting modifications of the procedure in order to standardize and simplify the process [6][7][8][9] . It remains a challenging surgery in order to achieve adequate lift of the eyelid while retaining proper eyelid contour.…”

Section: Introductionmentioning

confidence: 99%

The “central six” of ptosis repair: eliminating contour as a variable in external levator surgery

Adjei¹,

Nunery²,

Lee³

2020

PAR

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Aim: Eyelid contour is a key component to satisfactory lid position and appearance following ptosis repair, the components of which have been highly debated and remain difficult to objectively measure. We sought to minimize the number of intraoperative adjustments required and reduce reoperation rates by addressing only the central 6 mm of tarsus when reapproximating levator to the anterior surface of tarsus, thereby eliminating contour as an adjustable variable. Methods: All patients who underwent external levator resection with blepharoplasty for correction of involutional ptosis between 2012 and 2019 by a single surgeon at one center were retrospectively reviewed. Patients who underwent concomitant brow lifting surgery were excluded. The same technique was used for each eyelid with uniform suture placement. One 6-0 silk horizontal mattress suture was placed partial thickness through the superior third of tarsus 3 mm lateral to the center of tarsus; another was passed 3 mm medial to the center of tarsus. No sutures were placed outside of this central 6-mm zone. Patient fixation was used to determine lid height and symmetry. Once satisfactory, the sutures were tied down in a permanent fashion and the eyelid position again verified. In total, 153 eyelids in 85 patients were evaluated. Data obtained included preoperative and postoperative margin-to-reflex distance (MRD 1), intraoperative and postoperative complications, reoperation rates, and patient satisfaction with appearance of lid contour and symmetry. Results: The mean follow up time was 3.41 months. The mean preoperative MRD 1 was 1.05 mm. The mean postoperative was 3.18 mm. All patients had recovery of an anatomically normal temporal peak height. Two of 153 eyelids (1.31%) required reoperation due to residual ptosis or overcorrection. No patients had postoperative lagophthalmos. Ninety-one percent of patients who underwent bilateral surgery had satisfactory symmetry defined as less than or equal to 1-mm difference between right and left MRD 1. Eighty-two of the 85 patients were satisfied with their postoperative appearance. Conclusion: This simple and standardized technique for suture placement gives reliable and effective results for external elevator advancement for ptosis repair by eliminating contour as an adjustable variable. Addressing the central 6 mm of tarsus is not only paramount but also in and of itself satisfactory in achieving optimal contour during external levator resection, without regard to more medial or lateral lid anatomy.

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Standardized Suture Placement for Mini-invasive Ptosis Surgery

Abstract: The simplified method of suture placement for small-incision external levator advancement is an effective, safe, and efficient option for acquired ptosis correction.

Cited by 14 publications

References 22 publications

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Role of Algorithm-Based Levator Aponeurectomy in Small-Incision External Ptosis Surgery for Involutional Ptosis

Conjunctival Sparing Ptosis Correction by White-Line Advancement Technique

The “central six” of ptosis repair: eliminating contour as a variable in external levator surgery

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