Introduction

We present a novel method of performing upper eyelid ptosis correction with the levator advancement technique by using the levator musculo-aponeurotic junction as the key landmark. Using a formula that we developed, the location of fixation relative to this landmark can be predicted preoperatively with considerable accuracy. Our clinical experience and long-term outcomes with this technique are presented in this study.

Material and Methods
The inclusion criteria were Asian patients with mild to severe ptosis with at least moderate levator function. Patients with congenital or acquired ptosis, primary and revisional cases were all included. The location for the placement of the advancement sutures was measured from the musculo-aponeurotic junction of the upper eyelid levator. This distance was determined by a formula that takes into consideration 1) the amount of elevation of the upper eyelid margin needed, 2) the degree of compensatory brow elevation that is present and 3) eye dominance.

Results
One hundred and fifty-six Asian patients were included in this prospective study. Of these 148 were bilateral and 8 were unilateral corrections. The mean operative time was 72 minutes. The technique was predictable with resolution of symptoms of eyelid ptosis post-surgery and good long-term symmetry of the palpebral aperture and crisp upper eyelid creases. The formula for estimating the fixation point on the levator was accurate to within +/- 1mm in the majority of patients.

Conclusions
This novel technique provides a predictable and reliable approach for upper eyelid ptosis correction in Asian patients.

Keywords: ptosis; levator aponeurosis, Mueller’s muscle; upper eyelid; ageing; involution.