Ptosis surgery - what are the pros and cons of anterior vs posterior approach, when a revision upper bleph is also required?
Doctor Answers 4
Ptosis surgery - what are the pros and cons of anterior vs posterior approach
A very important question
I think that your question is very perceptive, and this a question I regularly ask my own registrars. In a nutshell, a posterior approach ptosis is a nice procedure but only suitable for patients with an adequate skin crease. The great strength of the anterior approach is the ability to control the skin crease. Whilst one can improve the skin crease with a posterior approach procedure to a degree, a case like yours where you have previously had surgery and where there has been scar tissue would mean that you would need an anterior approach for best results. I do share your feeling on this... Common sense would render it fairly absurd to make an incision in the skin for the bleph and then another behind the lid for the ptosis repair when the whole point of the posterior approach would be to avoid a skin scar!I'm just speculating, but I wonder whether the reason you are getting contradictory advice is that the surgeon in question probably only does posterior approach and may not be comfortable with an anterior revision which is more complex. One does tend to see this bias in surgeon procedure decisions quite often.
Ant vs post approach ptosis correction surgery
Hi Peta. Most of my oculoplastic colleagues in the UK still go for an anterior approach as that is how most of us have been trained. Increasingly there's a vogue though for a posterior approach as the recovery time is quicker, there's reduced risk of scarring of the skin and theoretically it makes more anatomical sense. Quite a few of my colleagues do report good results for contact lens related aponeurotic ptosis (with high creases) via a posterior approach (e.g. white line advancement surgery). I personally still prefer an anterior approach as I like to reform a skin crease properly and it's just an approach I'm most happy with. As you say it makes sense to go for an anterior approach if you need a revisional blepharoplasty anyway and seems illogical to cut through the skin and then again through the back conjunctiva. If the ptosis is very mild though then some surgeons prefer a posterior approach as they feel their results are more predictable plus they can offer adjustability post op. Either way the most important thing is find a surgeon whom you're most comfortable with. Both approaches have their pros and cons
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Posterior approach will not work for a high crease.
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