How is the levator muscle tightened in ptosis surgery?

Question

How is the muscle tightened/shortened during ptosis surgery? I'm trying to wrap my head around possible risks and long term side effects.

Chad C. Zatezalo, MD · Answer

During ptosis surgery, two muscle can be surgically manipulated, the levator muscle or mullers muscle.  The levator is typically accessed via the skin, and the mullers via the back surface of the eyelid (conjunctiva).  Each ptosis case is different and each surgeon usually has a preference for the type of surgery they like to perform.  Each of these are shortened during surgery, similar to cutting our a section of a curtain and attaching the two ends.  
Best
Dr Z

Mehryar (Ray) Taban, MD, FACS · Answer

There are 2 basic ways to tighten the levator muscle to correct eyelid ptosis, including 1) anterior or external approach using skin incision vs. 2) posterior or internal approach with hidden incision.  See following link for more details. Either procedure can be done under local anesthesia.

John J. Martin, Jr., MD · Answer

There are 2 muscles which elevate the eyelid.  The levator, which is closer to the skin, and Mueller's muscle which is on the inside.  Through a skin incision the levator muscle can be located.  A segment of the muscle is excised and the muscle is then sutured together.  This basically shortens and tightens the muscle which will then be able to more effectively elevate the eyelid.

Richard G. Reish, MD, FACS · Answer

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

Katrinka L. Heher, MD · Answer

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.

David Cheung, MBChB, Bsc(Hons), FRCOphth · Answer

Hi there. Greetings from the UK. There are various ways that we oculoplastic surgeons correct a ptosis via tightening the levator aponeurosis. We rarely operate on muscle per se but can do for severe types of ptosis e.g. dysgenetic congenital ptosis.
For most patients with the most common type of acquired aponeurotic ptosis, we either repair/ advance or reattach the levator aponeurosis tendon either via an anterior skin crease approach or posteriorly via a transconjunctival approach. Both methods has their advocates and risks and benefits. Risks with any type of surgery on the levator aponeurosis therefore result from inadvertent damage to surrounding structures, overcorrection/ undercorrection/ infection or scarring. Hence it's important that whomever you see for your ptosis can demonstrate their experience as it's fairly complex anatomy and isn't simple blepharoplasty surgery. 
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David

Talon Maningas, DO · Answer

Usually sutures are used to repair the muscles that have weakened and stretched out causing upper lid ptosis. Your qualified surgeon should go over all the risks and potential long term side effects of surgery. Make sure to vocalize your concerns so they can be addressed during your consultation.

Randy J. Buckspan, MD (retired) · Answer

Good question!  The levator muscle is beneath the skin of the upper eyelid and is relatively thin and wide.  The attachments at the ends are like tendons, allowing the muscle to pull up on the edge of the eyelid.  With age or genetics or trauma, the "tendons" may stretch - effectively lengthening the muscle and it's attachments and allowing the edge of the eyelid to drop, or droop.  During ptosis surgery, this lengthened "tendon" is shortened, returning the levator and attachments to their proper length, and the edge of the eyelid up to the correct position.  The procedure is commonly done through the same incision used for upper eyelid surgery, or blepharoplasty.  Risks are minimal, and the results should provide long-term improvement.  After an examination and consultation, your plastic surgeon can give you specific details and recommendations.

How is the levator muscle tightened in ptosis surgery?

Answers (8)

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