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Correction Surgery

Anatomy of the Eye and Ptosis

There are two muscles that are responsible for raising or elevating the eyelid—the levator muscle and the Müller's muscle. The levator muscle is a more superficial muscle and sits above the Müller's muscle. These two muscles work in concert to lift the eyelid. The levator muscle is controlled by voluntary signaling, whereas the Müller's muscle is controlled by involuntary signaling. Patients with severe congenital ptosis have a weakening of both levator and Müller's muscle, therefore correction requires tightening of both muscles. In mild to moderate cases, ptosis surgery can be performed with correction of Müller's muscle only. In patients with acquired ptosis, correction requires the strengthening of the levator muscle or the Müller's muscle. In this case, determining which muscle to correct is based on which muscle is dysfunctional.

Correction Surgery

The traditional method of the surgical correction of ptosis was merely the tightening of the levator muscle. This method was further advanced with the tightening of the levator as well as the Müller's muscles, providing more efficiency. The latest advancement involves a minimally invasive technique which is done by plicating or resecting the muscle without making an incision on the skin. This method can be performed on patients with borderline to moderate ptosis. Borderline ptosis can be difficult to correct with the traditional open technique, as fine ptosis requires a very fine tightening of the muscle. Non-incisional ptosis correction method is definitely useful for patients with borderline ptosis. This involves flipping the eyelid and working on the inner, deep aspect of the eyelid. This technique is especially useful when the patient has a prior eyelid surgery and would like to avoid having further incisions. The result is less traumatic to the eyelid tissue since less additional surgical incision is made. It is also helpful in creating the most natural and dynamic double eyelid fold, as the anatomy that is involved in fold formation is not disturbed. Another advancement with ptosis correction involves simultaneously tightening both muscles in severe ptosis to provide maximal efficiency and durability to the ptosis repair compared to the prior method.