Introduction to Levator Aponeurosis Resection

What is/are Levator Aponeurosis?

Levator Aponeurosis - BACKGROUND Conventional blepharoptosis repair methods distort the normal anatomy of levator aponeurosis and often cause a visible depressed scar in the upper eyelid. ^[1] Objective To observe the efficacy of the surgery of levator palpebrae superioris resection conserving distal levator aponeurosis. ^[2] Using the fusion of the levator aponeurosis with septum as a pedicle, the lower part of the orbital septum was turned downward and then sutured to the upper border of the lower orbicularis oculi muscle and posterior pretarsal fascia. ^[3] Objective: Our aim was to analyze the success rates of patients who underwent levator aponeurosis or frontal suspension with silicone tube surgery due to blepharoptosis according to the elevator function (LF) and to compare our results with the literature. ^[4] Methods: This retrospective case-control study included patients with moderate and severe simple congenital ptosis who underwent skin approach levator aponeurosis resection (LR) as a primary procedure with a minimum of 6-month follow up. ^[5] The use of a full-thickness graded blepharotomy technique through the levator aponeurosis, Muller’s muscle, and conjunctiva provides both an effective and predictable surgical treatment to help patients with mild to severe eyelid retraction. ^[6] We present a partially open technique that achieves a soft, natural eyelid crease by recreating the normal anatomic attachments without a deeper dissection between the levator aponeurosis and the anterior lamella. ^[7] The residual levator aponeurosis and posterior lamellar were connected to the transplanted ear cartilage. ^[8] This case highlights the importance of taking great care when advancing the levator muscle in ptosis due to levator aponeurosis dehiscence, particularly in elderly patients, so as to avoid vertically folding the superior tarsal plate. ^[9] 2g were assembled to create desired weight and placed in supratarsal location after levator aponeurosis recession. ^[10] Ptosis in elderly patients most commonly presents as dehiscence of the levator aponeurosis insertion and thinning of the aponeurotic fibers [1]. ^[11] Lateral double fold reinforcement may be performed in older patients, where the OOM is sutured and fixed on to the levator aponeurosis in the lateral canthal area to prevent the lateral double fold from fading. ^[12] The authors’ technique leaves the orbital septum intact, mobilizing the inferior flap in the retro-orbicularis oculi plane, lifting the pretarsal orbicularis oculi off the anterior tarsus and fixating the pretarsal orbicularis oculi to the lower edge of the levator aponeurosis at the fusion point of the levator with the orbital septum. ^[13] The upper eyelid crease was lowered, blepharoptosis was corrected by anterior levator aponeurosis resection ptosis surgery, eyelash ptosis was corrected with anchor blepharoplasty, and upper eyelid fold volume was restored using anterior orbital fat. ^[14] The aims of this study were to present the clinical results of a modified technique using levator aponeurosis–Müller muscle–reinforced plication for blepharoptosis correction and to demonstrate its advantages over conventional advancement or plication methods. ^[15] Unilateral levator aponeurosis excision and frontalis suspension is an efficient approach for MGJWS. ^[16] The difference between hard and soft contact lenses in material, size, shape and thickness of the lens margin, could lead to variances in mechanical trauma of the levator aponeurosis. ^[17] Then joint fascia was reconstructed to format " Y" flap, on which both sides of the levator aponeurosis and orbital septum fascia were tightened and the redundant fat and fascial organization removed. ^[18] And the thickness of the levator aponeurosis was found to be correlated with the levator function in congenital dysmyogenic blepharoptosis. ^[19] The free end of muscle flap was fixed to a higher position of the levator aponeurosis. ^[20]

levator aponeurosis resection

Methods: This retrospective case-control study included patients with moderate and severe simple congenital ptosis who underwent skin approach levator aponeurosis resection (LR) as a primary procedure with a minimum of 6-month follow up. ^[1] The upper eyelid crease was lowered, blepharoptosis was corrected by anterior levator aponeurosis resection ptosis surgery, eyelash ptosis was corrected with anchor blepharoplasty, and upper eyelid fold volume was restored using anterior orbital fat. ^[2]