How is the levator muscle tightened in ptosis surgery?

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  Ptosis usually happens when dehiscence of the levator muscle happens.  Ptosis surgery can be performed by suturing the levator muscle.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

I'm a big fan of placing a single permanent stitch to reattach the levator tendon.  If your lid droop is caused by a slipped levator then I believe the best results can be obtained by reproducing the original anatomy. The goal is to achieve the right height and contour of the lid and this depends on the exact placement of the stitch to reconnect the levator.  The key is to go to a surgeon who does a ton of these! Hope this helps and best of luck.