Ptosis Surgery: Comparing Different Surgical Techniques

  • Alon Skaat
  • Guy Jonathan Ben Simon


Surgical techniques for the treatment of ptosis are varied, presenting the surgeon with a complex repertoire of options. The treatment plan should be best matched to each individual case, based on the etiology, severity of the ptosis, levator function, and surgeon’s experience. Therefore familiarity with the different surgical techniques, their indications, advantages, and disadvantages may help the surgeon in making the best clinical decision. This chapter reviews the clinical outcome data in ptosis surgery based on comparative studies, comparing different surgical techniques, such as levator resection vs. Müller’s muscle resection vs. Fasanella–Servat for involutional ptosis, frontalis suspension via autogenous fascia vs. banked fascia vs. an alloplastic material (silicone, Gortex, and Supramyd) for poor levator function ptosis, and levator resection vs. frontalis suspension for congenital ptosis.


Lacrimal Gland Meibomian Gland Lateral Horn Frontalis Suspension Levator Function 
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  1. 1.
    Park DH, Jung JM, Song CH. Anthropometric analysis of levator muscle function. Plast Reconstr Surg. 2008;121:1181–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Cetinkaya A, Brannan PA. Ptosis repair options and algorithm. Curr Opin Ophthalmol. 2008;19:428–34.CrossRefPubMedGoogle Scholar
  3. 3.
    McCulley TJ, Kersten RC, Kulwin DR, Feuer WJ. Outcome and influencing factors of external levator palpebrae superioris aponeurosis advancement for blepharoptosis. Ophthal Plast Reconstr Surg. 2003;19:388–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Ben Simon GJ, Lee S, Schwarcz RM, McCann JD, Goldberg RA. External levator advancement vs Müller’s muscle-conjunctival resection for correction of upper eyelid involutional ptosis. Am J Ophthalmol. 2005;140:426–32.CrossRefPubMedGoogle Scholar
  5. 5.
    Pang NK, Newsom RW, Oestreicher JH, Chung HT, Harvey JT. Fasanella-Servat procedure: indications, efficacy, and complications. Can J Ophthalmol. 2008;43:84–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Skibell BC, Harvey JH, Oestreicher JH, Howarth D, Gibbs A, Wegrynowski T, et al. Adrenergic receptors in the ptotic human eyelid: correlation with phenylephrine testing and surgical success in ptosis repair. Ophthal Plast Reconstr Surg. 2007;23:367–71.CrossRefPubMedGoogle Scholar
  7. 7.
    Wasserman BN, Sprunger DT, Helveston EM. Comparison of materials used in frontalis suspension. Arch Ophthalmol. 2001;119:687–91.PubMedGoogle Scholar
  8. 8.
    Ben Simon GJ, Macedo AA, Schwarcz RM, Wang DY, McCann JD, Goldberg RA. Frontalis suspension for upper eyelid ptosis: evaluation of different surgical designs and suture material. Am J Ophthalmol. 2005;140:877–85.CrossRefPubMedGoogle Scholar
  9. 9.
    Wilson ME, Johnson RW. Congenital ptosis. Long-term results of treatment using lyophilized fascia lata for frontalis suspensions. Ophthalmology. 1991;98:1234–7.PubMedGoogle Scholar
  10. 10.
    Yoon JS, Lee SY. Long-term functional and cosmetic outcomes after frontalis suspension using autogenous fascia lata for pediatric congenital ptosis. Ophthalmology. 2009;116:1405–14.CrossRefPubMedGoogle Scholar
  11. 11.
    Bajaj MS, Sastry SS, Ghose S, Betharia SM, Pushker N. Evaluation of polytetrafluoroethylene suture for frontalis suspension as compared to polybutrylate-coated braided polyester. Clin Exp Ophthalmol. 2004;32:415–9.CrossRefGoogle Scholar
  12. 12.
    Liu D. Blepharoptosis correction with frontalis suspension using a nylon monofilament sling: duration of effect. Am J Ophthalmol. 1999;128:772–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Hersh D, Martin FJ, Rowe NJ. Comparison of silastic and banked fascia lata in pediatric frontalis suspension. J Pediatr Ophthalmol Strabismus. 2006;43:212–8.PubMedGoogle Scholar
  14. 14.
    Esmaeli B, Chung H, Pashby RC. Long-term results of frontalis suspension using irradiated, banked fascia lata. Ophthal Plast Reconstr Surg. 1998;14:159–63.CrossRefPubMedGoogle Scholar
  15. 15.
    Carter S, Meecham WJ, Steiff SR. Silicone frontalis slings for the correction of blepharoptosis: indications and efficacy. Ophthalmology. 1996;103:623–30.PubMedGoogle Scholar
  16. 16.
    Wagner RS, Mauriello Jr JA, Nelson LB, Calhoun JH, Flanagan JC, Harley RD. Treatment of congenital ptosis with frontalis suspension: a comparison of suspensory materials. Ophthalmology. 1984;91:245–8.PubMedGoogle Scholar
  17. 17.
    Metha P, Patel P, Olver JM. Functional results and complications of polyester mesh use for frontalis suspension ptosis surgery. Br J Ophthalmol. 2004;88:361–4.CrossRefGoogle Scholar
  18. 18.
    Cates CA, Tyers AG. Outcomes of anterior levator resection in congenital blepharoptosis. Eye. 2001;15:770–3.PubMedGoogle Scholar
  19. 19.
    Park DH, Choi WS, Yoon SH, Shim JS. Comparison of levator resection and frontalis muscle transfer in the treatment of severe blepharoptosis. Ann Plast Surg. 2007;59:388–92.CrossRefPubMedGoogle Scholar
  20. 20.
    Yip CC, Goldberg RA, Cook TL, McCann JD. Incision-less frontalis suspension. Br J Ophthalmol. 2004;88:585–6.CrossRefPubMedGoogle Scholar
  21. 21.
    Singh D. Orbicularis plication for ptosis: a third alternative. Ann Ophthalmol. 2006;38:185–93.CrossRefGoogle Scholar
  22. 22.
    Mauriello JA, Wagner RS, Caputo AR, Natale B, Lister M. Treatment of congenital ptosis by maximal levator resection. Ophthalmology. 1986;93:466–9.PubMedGoogle Scholar
  23. 23.
    Press UP, Hubner H. Maximal levator resection in the treatment of unilateral congenital ptosis with poor levator function. Orbit. 2001;20:125–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Anderson RL, Jordan DR, Dutton JJ. Whitnall’s sling for poor function ptosis. Arch Ophthalmol. 1990;108:1628–32.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.The Goldschleger Eye Institute, Sheba Medical CenterTel HashomerIsrael

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