ArticlePDF Available

Blepharoptosis Correction with Stitch Method (매몰법을 이용한 일측성의 경미한 안검하수 교정)

Authors:
Tae Joo Ahn at SUI plastic surgery
Tae Joo Ahn
  • SUI plastic surgery
Download full-text PDFDownload full-text PDF
Read full-text
Download citation

Abstract

Blepharoptosis Correction with Stitch Method Tae Joo Ahn, M.D. Aran Plastic Surgery, Seoul, Korea There are various methods to correct mild ptosis and to make a double fold. However, all preexisting methods have similar disadvantages, such as long-lasting swelling and down time. Recently, many patients prefer more convenient and minimal invasive methods with faster recovery. So we have devised a new technique to correct mild ptosis. Our technique is very similar to other nonincisional stitch methods. We try to correct ptosis through Müller's muscle tucking using the nonincisional stitch method. We think this method could be applied to mild degree ptosis. We hope to report the long-term follow up data of our cases and analysis with more efficient technique in the near future. (J Korean Soc Aesthetic Plast Surg 16: 00, 2010) Key Words: Blepharoptosis, Eyelid surgery, Stitch method, Müller's muscle tucking
9-안태주 선
생님.pdf
Content uploaded by Tae Joo Ahn
Author content
All content in this area was uploaded by Tae Joo Ahn on Jan 19, 2016
Content may be subject to copyright.
Ahn.pd
f
Content uploaded by Tae Joo Ahn
Author content
All content in this area was uploaded by Tae Joo Ahn on Nov 18, 2015
Content may be subject to copyright.
140
서 론I.
현대인에 있어 눈은 심미적으로나 인상에 있어 영향을
많이 받는 부위 중의 하나이다 이러한 경향에 따라 예전에
.
관심이 적었던 경증의 안검하수에 대해서도 관심이 많아
지고 있다
.
안검하수는 정도에 따라 다양하게 나누어지고 또한 교
정방법도 다양하게 있다 이러한 교정은 대부분 붓기나
1.
회복기간이 길어 아주 약한 정도의 안검하수일 경우 수술
을 권하거나 교정하기가 쉽지 않았다 하지만 최근 바쁜 현
.
대인을 위해 새로운 시도들이 많이 시행되고 있으며 저자
가 소개하고자 하는 매몰법을 통한 경도의 안검하수 교정
술도 하나의 방법으로써 시행될 수 있을 것으로 생각한다
.
신고안II.
가 수술방법.
먼저 매몰법은 삼각단매듭연속법으로 시행하였다
(Fig.
1).
저자가 하는 삼각단매듭연속법은 작은 절개창
(slit inci-
을 개가량 넣고 내측에서외측까지 번에서 까지번
sion) 5 , 1 5
호를 붙인다 번 절개창에서 번 절개창으로 피부 아래로
. 4 3
봉합사를 삽입하기 시작하여 번에서 번으로는 결막을
, 3 2
통과하였다가 나오고 번에서 번으로는 피부 아래로 번
, 2 1 1
에서 번으로는 결막을 통해 나온다 이러한 과정을 반복
2 .
하면 전체적인 삼각단매듭 연속매몰법이 완성된다
.
이러한 방법에 추가하여 씨 근육의 주름잡기
Müller
를 시켜 준다
(Müller's muscle tucking) (Fig. 2).
번 에서 번 으로 이동하는 동안 결막을 통과하게
3 slit 4 slit
되는데 결막에서 나오면 바로 피부쪽으로 다시 나오는 것
이 아니라 결막쪽에서 후측벽
,
을 따라
(posterior wall) Müller
씨 근육이 존재하는 상측 방향으로
(superior) 8
가량 올
mm
라갔다가 내려오며 씨 근육의 주름잡기
Müller
를
(tucking)
한 후에 피부로 나오도록 한다
(Fig. 3).
매몰법을 이용한 일측성의 경미한 안검하수 교정
안 태 주
아란성형외과
Blepharoptosis Correction with Stitch Method
Tae Joo Ahn, M.D.
Aran Plastic Surgery, Seoul, Korea
There are various methods to correct mild ptosis and to make a double fold. However, all pre-
existing methods have similar disadvantages, such as long-lasting swelling and down time. Recently,
many patients prefer more convenient and minimal invasive methods with faster recovery. So we
have devised a new technique to correct mild ptosis. Our technique is very similar to other non-
incisional stitch methods. We try to correct ptosis through Müller's muscle tucking using the non-
incisional stitch method. We think this method could be applied to mild degree ptosis. We hope to
report the long-term follow up data of our cases and analysis with more efficient technique in the near
future. (
J Korean Soc Aesthetic Plast Surg
16: 00, 2010)
Key Words: Blepharoptosis, Eyelid surgery, Stitch method, Müller's muscle tucking
Received January 29, 2010
Revised April 29, 2010
Accepted May 20, 2010
Address Correspondence : Tae-joo Ahn, M.D., Aran Plastic
Surgery, 2F, Sambo B/D 910-9, Bangbae-dong, Seocho-
gu, Seoul 137-842, Korea. Tel: 82-2-3474-2879 / Fax:
82-2- 3474-2878 / E-mail: cmcanti@hanmail.net
*본 논문은 제 차 대한성형외과학회 추계학술대회에서67 Interactive
발표됨Video .
JKorean Soc Aesthetic Plast Surg
대한미용성형외과학회지 제 16 권, 제 3 호
Vol. 16, No. 3, 00 - 00, 2010
141
안태주: Ptosis Correction with Stitch Method
정도에 따라 번에서 번으로 결막을 통해 통과 할 때도
3 2
씨 근육의 주름잡기
Müller
를 시행할 수 있다
(tucking) .
증례1
세 여자 내원 년 전에 환자가 원하여 절개를 하지 않으면
24 , 2
서양쪽에삼각단매듭연속매몰법으로쌍꺼풀수술을한 상태로
,
왼쪽 눈의쌍커풀이 간헐적으로 풀린다며 내원하였다
.
측정결과 매몰법 시행 전과 비슷하게 우측의 안검수직거리
가 일 때 좌측은 로 측정되었다
(vertical fissure) 10 mm 8.5 mm .
절개법과 일반적인안검하수수술을 거부하여 매몰법을좌측
에 시행하면서 앞서 설명한 매몰법과 씨 근육의 주름잡기
, Müller
를 같이 시행하였다
.
술후 개월간 관찰결과 우측과 좌측이 로 안검수직거
10 9 mm
리 가 잘 유지되었다
(vertical fissure) (Fig. 4).
증례 2
세 여자 쌍꺼풀 수술을 받고 싶다며 내원하였다 측정결과
22 , .
우측의 안검수직거리가
8
이고 좌측은
mm , 6.5
로 측정되었
mm
다 우측은 삼각단매듭연속매몰법을 시행하였고 좌측은 매몰
. ,
법을 시행하면서 씨 근육의 주름잡기를 같이 시행하였다
Müller .
술후 개월간 관찰결과 우측 좌측
4 8, 7.5
로 안검수직거리가
mm
잘 유지되었다
(Fig. 5).
Fig. 1. Triangular single-knot stitch method. (Left) External view. (Right) Schematic diagram of coronal section.
Fig. 2. Müller's muscle tucking during the process of stitch-method double fold surgery. (Above, left) Design of one loop for
Müller's muscle tucking. (Above, right) Schematic diagram, Thick arrow indicates Müller's muscle tucking procedure. (Below,
left) With traction to expose the tarsal plate upper margin, Müller's muscle tucking can be performed without incision. (Below,
right) Design of two loops for Müller's muscle tucking.
142
대한미용성형외과학회지 Vol. 16, No. 3, 2010
고 찰III.
안검하수는 원인을 분석하고 정도에 따라 다양한 방법
으로 교정할 수 있다 많은 발표들이 정리되어 있는데 그 중
.
의 하나로
Finsterer1
는 안검하수의 원인을 근성
(Myogenic),
신경성 건막성
(Neurogenic),
역학적
(Aponeurotic), (Mechanical),
외상성 가성안검하수
(Traumatic),
등으로 구
(Pseudoptosis)
분하고 각각의 원인과 정도에 따라 보존적
(conservative),
법 근절제법
Fasanella-Servat , Müller (Müller's muscle conjuntival
건막전진술
resection),
건막절제술
(Levator advancement),
눈썹 전두근 현수법
(Levator resection), / (Brow/frontalis sus-
등의 치료방법을 제시하였다 하지만
pension techniques) .
많은 경우에서 일정크기 이상의 절개를 하게 되고 이러한
과정에붓기나혈종 등을 초래할 수 있으며 회복기간이 길
어지는 단점이 있었다
.
등
Ayala 2
에 의하면 근 절제법
Müller (conjunctival- Müller-
를 시행할 경우에 절제 폭에 따라 안검하수
ectomy) (ptosis)
교정을 예상할 수 있는데 안검하수에서는 의
2 mm 10 mm
절제 의 안검하수에서는 의 안검하수에
, 1.5 mm 8 mm, 1 mm
서는 절제를 제시하였다
6 mm .
최근 모든 수술의 경향은 가능하면 간단하면서도 회복
기간이 빠른 수술 방법들이 선호되는 경향이 있어 저자들
Fig. 3. Müller's muscle tucking during the process of stitch-
method double fold surgery are shown in cross section.
Fig. 4. (Case 1). Ptosis correction with stitch method in a
24-year-old female patient. (Left) Preoperative appearance.
Left eyelid reveals ptotic state. (Right) Postoperative
appearance at 10 months.
Fig. 5. (Case 2). Ptosis correction with stitch method in a
22-year-old femal patient. (Left) Preoperative appearance.
Left eyelid shows ptotic state. (Right) Postoperative
appearance at 4 months.
143
안태주: Ptosis Correction with Stitch Method
은 비교적 간단히 경도의 안검하수를 교정해 볼 수 있는 방
법을 고안하여 시도하여 보았다
.
저자의 방법은 근과 상안검거근막의절개가 전혀
Müller
없는 것이 특징이라 할 수 있겠다
.
저자들의 경우 례에서는 같은 방법으로 경도의 안검
30
하수 교정을 양측에서 시행하여 보았지만 기존에 쌍꺼풀
이 없는 경우 피부 처짐이 있다가 없어짐으로서 눈이 커져
,
보이는 것인지 아니면 저자들의 매몰식 씨 근육 주
, Müller
름잡기 의 효과가 있는 것인지의 판별이 사진만으
(tucking)
로는 판단하기가 어려웠다 하지만 보고한 증례들처럼 한
.
쪽 눈만 안검하수가 있는 경우에 적용을 하여 좋은 결과를
얻음으로써 이 방법이 비교적 효과가 있음을 알 수 있게 되
었다 다만 헤링씨 법칙
.
에 의해 한쪽 눈의 하
(Herring's law)
수 교정이 더 효과적으로 보일 수 있음도 고려해 보아야 할
것이다
.
또한 증례 의 경우는 안검하수라기 보다 상대적으로
, 1
왼쪽이 오른쪽에 비해 눈뜨는 힘이 약한 상태로 볼 수도 있
을 것이다 이러한 경우라도 왼쪽의 씨 근육의 주름
. Müller
잡기만으로 효과적으로 개선할 수 있었다
.
그리고 아직 추적 기간이 짧아 앞으로 양쪽을 같이 적용
한 예들과 함께 장기간의 자료를 모아 분석한 후 그 결과를
보고하여야 할 숙제가 남아 있다고 생각한다
.
등
Hirasawa 3
은 눈꺼풀올림근은 수의근
(voluntary muscle)
인 빠르게 수축하는 근섬유 와 불
(fast-twitch muscle fiber) ,
수의 근인 느린수축근섬유
(involuntary muscle) (slow-twitch
로 구성되어 있다고 하였다 또 초기의 수의근
muscle fiber) . ,
이 빠르게 수축하여 씨 근육의 늘어남
Müller
이
(stretching)
생기고 반사작용으로 불수의근이 눈뜨는 힘을 지속시켜
,
주는 것으로 보고 하였다 저자는 이러한 기전에서 젊은 사
.
람이면서 일측성이고 한쪽 눈뜨는 힘이 약한 경우에
, ,
씨 근육의 주름잡기로 반사작용을 강화시켜주는 역
Müller
할을 하는 것으로 생각하고 있다
.
등
Ryu 4
이나 등
Kim 5
이 보고한 것처럼 비절개식 상안검
성형술은 동양의 젊은 여성에서 선호되고 있는 쌍꺼풀 방
법의 하나이다 빠르게 변화하는 현대사회에서 회복기간
.
을 단축하면서도 약한 정도의 안검하수도 교정하고자 바
라는 경우가 많이 있다 본 방법으로 이렇게 약한 안검하수
.
가 있는 경우에 적용하여 보다 편리하면서도 만족스러운
결과를 얻어 보고하는 바이다
.
REFERENCES
1. Finsterer J: Ptosis: causes, presentation, and management.
Aesthetic Plast Surg 7:193, 2003
2. Ayala E, Gálvez C, González-Candial M, Medel R: Predictabi-
lity of conjunctival-Müellerectomy for blepharoptosis repair.
Orbit 26:217, 2007
3. Hirasawa C, Matsuo K, Kikuchi N, Osada Y, Shinohara H,
Yuzuriha S: Upgaze eyelid position allows differentiation be-
tween congenital and aponeurotic blepharoptosis according to
the neurophysiology of eyelid retraction. Ann Plast Surg 57:529,
2006
4. RyuHS, Kum IS, Minn KW: Cosmetic double eyelid surgery:
single 5 mm-partial incision method. J Korean Soc Plast Reconstr
Surg 29:521, 2002
5. Kim YK, Kwon JD, Oh KS: Double eyelid operation with
three tiny incisions. J Korean Soc Plast Reconstr Surg 27:195, 2000
... In essence, the 5-point method is used. A CFS sling is made at the halfway point when moving from No. 3 to No. 4 ( Fig. 5A and B) [1,5]. ...
... The suture is passed just below the skin from No. 4 to No. 3 and is then passed through the conjunctiva from No. 3 to No. 2. Passing below the skin from No. 2 to No. 1 and through the conjunctiva from No. 1 to No. 2 is repeated, thereby completing the triangular single-knot stitch method(Fig. 2)[1][2][3]. ...
An overview of minimal incisional ptosis correction: A surgeon’s perspective
Article
Full-text available
  • Jan 2020
People increasingly prefer fast and convenient methods for aesthetic procedures in busy modern society. Therefore, physicians and patients increasingly desire to improve cases of mild ptosis of the eyes in a simpler way. The purpose of this review is to organize the surgical methods of minimal incisional ptosis correction that the author has developed to satisfy this need and to examine the indications of each method and its advantages and disadvantages. The basic technique is a triangular single-knot stitch method using five points. Additionally, the method of applying a special loop (tucking the Müller muscle by pulling the conjoint fascial sheath) and the method of combining a non-incisional method with making a loop will be explained herein.
View
... Shimizu et al. [2] utilized two to four separate threads to narrow the gap between the tarsus and levator muscle, which, in effect, plicates the Muller's muscle for ptosis correction. Around the same time, we introduced our method of nonincisional ptosis correction by tucking Muller's muscle through the triangular stitch method [3]. This method is composed of a single, running suture that locks soft tissue between the conjunctiva and Muller's muscle in a triangular configuration, which allows the thread to work as a loop or a sling in pulling up as much soft tissue as possible to correct ptosis. ...
... The method for correcting blepharoptosis varies depending upon its severity and cause. Numerous operative methods have been reported; however, variables such as local anesthetics, hematoma, swelling, and elasticity of the muscle make verifying and adjusting the degree of ptosis correction challenging with these methods [2,3]. Capitalizing on our experience with the non-incisional method for simultaneous double eyelid and ptosis correction, the current technique was crafted to: 1) allow the creation of a double eyelid fold in patients with loose or thick skin; 2) minimize the risk of complications in cases of mild ptosis by simplifying the procedure and maintaining integrity of the posterior lamella through the non-incisional method; and 3) minimize asymmetry in ptosis correction while eliminating the need for the patient to sit up during the procedure to check for symmetry. ...
Mild Ptosis Correction with the Stitch Method During Incisional Double Fold Formation
Article
Full-text available
  • Jan 2014
Numerous methods exist for simultaneous correction of mild blepharoptosis during double eyelid surgery. These methods are generally categorized into either incisional (open) or non-incisional (suture) methods. The incisional method is commonly used for the creation of the double eyelid crease in patients with excessive or thick skin. However, concurrent open ptosis correction is often marred by the lengthy period of intraoperative adjustment, causing more swelling, a longer recovery time, and an increased risk of postoperative complications. The authors have devised a new, minimally invasive technique to alleviate mild ptosis during incisional double eyelid surgery. The anterior lamella is approached through the incisional technique for the creation of a double eyelid while the posterior lamella, including Muller's and levator muscles, is approached with the suture method for Muller's plication and ptosis correction. The procedure described was utilized in 28 patients from June 2012 to August 2012. Postoperative asymmetry was noted in one patient who had severe preoperative conjunctival scarring. Otherwise, ptosis was corrected as planned in the rest of the cases and all of the patients were satisfied with their postoperative appearance and experienced no complications. Our hybrid technique combines the benefits of both the incisional and suture methods, allowing for a predictable and easily reproducible correction of blepharoptosis with an aesthetically pleasing double eyelid.
View
... Since Ahn and Shimizu introduced nonincisional methods for ptosis correction in 2010, several other techniques have been described. 8,[11][12][13] These methods generally involve suspending the levator and/or Müller muscles to effect and are touted for their simplicity and the ability to achieve satisfactory correction with minimal incision, dissection, scarring, and recovery time. Moreover, secondary procedures are easier to perform because sutures are relatively easy to remove and one can either remove or add additional sutures to effect. ...
Nonincisional Conjoint Fascial Sheath Suspension: A Novel Technique for Minimally Invasive Blepharoptosis Correction
Article
  • Aug 2017
Background: Mild to moderate blepharoptosis, or ptosis, is relatively common among Asians, and it is not uncommon to offer ptosis correction at the time of double-eyelid surgery in this patient population. The traditional open approaches to ptosis correction are subject to scarring and prolonged recovery time, whereas the newer nonincisional approaches are marred by issues of incomplete correction or recurrence. This study describes a new nonincisional technique that overcomes the limitations of current methods by using conjoint fascial sheath (CFS) for suspension. Methods: From January 2014 to April 2015, a retrospective review was conducted on 21 patients (41 eyelids) who underwent simultaneous nonincisional ptosis correction and double-eyelid surgery. All patients had either mild or moderate ptosis without excess skin hooding and excellent or good levator palpebrae function. Results: Mild ptosis correction (1-loop CFS suspension) was performed in 25 eyelids, and moderate ptosis correction (2-loop CFS suspension) was performed in 16 eyelids. At 6 months of follow-up, 23 eyelids (56.1 %) improved to "normal" with overall improvement seen in 33 eyelids (80.0%). The mean marginal reflex distance 1 increased from 3.16 ± 0.61 mm preoperatively to 4.11 ± 0.61 mm postoperatively, which was statistically significant (P < 0.001). Conclusions: Mild to moderate ptosis correction with nonincisional CFS suspension technique is a safe and effective method that combines the benefits of nonincisional procedure with longevity and precision seen in the traditional open approaches. The procedure is easy to perform with minimal recovery time and high patient satisfaction and can be combined with nonincisional double-eyelid surgery.
View
... It is generally known that if a fold is made without an incision, it is likely to disappear. 15 However, despite several reports on the disappearance rate, there have been few reports on its related causes and measurements. The cheese-cutting effect is the term used to describe what happens when the skin is sutured to the tarsal plate or the weak levator aponeurosis-Müller muscle complex using 7-0 nylon. ...
Subclinical Ptosis Correction: Incision, Partial Incision, and Nonincision: The Formation of the Double Fold
Article
  • Aug 2015
Surgery to create eyelid folds accounts for the highest percentage of surgeries in Asians and Koreans who receive the surgery on the upper eyelid 2 to 3 times during their lifetimes for functional or cosmetic reasons. Patients are generally satisfied with the results-the eyes becoming brighter and bigger via the improvement of pseudoptosis by fold creation. The recent trend is to seek the "perfect" eye: a vertically and horizontally big palpebral fissure with more than 90% cornea showing. Surgery of the levator aponeurosis-Müller muscle complex is required to expose the cornea, except in those patients who inherently have good levator-Müller function. However, many complications occur during surgeries of the levator aponeurosis-Müller muscle complex, which increase the reoperation rate. Here, the authors briefly summarize recent experiences correcting subclinical ptosis using the nonincision, incision, and partial incision methods.
View
... No potential conflict of interest relevant to this article was reported. countries to utilize blepharoptosis repair techniques in conjunction with double eyelid blepharoplasty for the aesthetic purpose of increasing the aperture of the eye, which is viewed as more attractive in this patient population [2][3][4]. However, the concept of combining these techniques is not new and is used around the world [5][6][7]. ...
The Relationship Between Eyebrow Elevation and Height of the Palpebral Fissure: Should Postoperative Brow Descent be Taken into Consideration When Determining the Amount of Blepharoptosis Correction?
Article
Full-text available
  • Feb 2014
Combining blepharoptosis correction with double eyelid blepharoplasty is common in East Asian countries where larger eyes are viewed as attractive. This trend has made understanding the relationship between brow position and height of the palpebral fissure all the more important in understanding post-operative results. In this study, authors attempt to quantify this relationship in order to assess whether the expected postoperative brow descent should be taken into consideration when determining the amount of ptosis to correct.
View
Blepharoptosis correction transconjunctivally using buried suture method: A Prospective Cohort Study
Article
  • Nov 2015
  • Int J Surg
Background: Blepharoptosis correction with minimal eyelid scarring is a desirable outcome. The aim of this study was to describe in detail our method of blepharoptosis correction transconjunctivally using buried suture method and to demonstrate its effectiveness. Methods: From June 2012 to May 2013, we performed a blepharoptosis correction transconjunctivally using buried suture method on 458 eyelids in 245 patients. During this procedure, we utilized six separate threads to form multiple knots. This thread was transconjunctivally inserted into the point located above the superior tarsal margin involving the superior levator palpebral and Müller muscles. Results: A total of 409 eyelids (89%) were successfully corrected. Undercorrection was encountered in 49 eyelids (25 patients). Of the 25 patients, only 16 patients were dissatisfied with the undercorrection and thus underwent reoperation. Three patients with asymmetric double eyelid ptosis also underwent reoperation. Five patients required reoperation to correct eyelid fold loosening, which occurred during the follow-up period. No major complications such as overcorrection, persistent irritation, and keratitis were observed. Conclusions: Using our technique, we could achieve the desired correction by accurately checking the rate of correction. We have demonstrated here excellent predictability and success rate in mild and moderate ptosis. We believe that a blepharoptosis correction transconjunctivally using buried suture method is an effective treatment method.
View
Ptosis: Causes, Presentation, and Management
Article
  • Jun 2003
Drooping of the upper eyelid (upper eyelid ptosis) may be minimal (1-2 mm), moderate (3-4 mm), or severe (>4 mm), covering the pupil entirely. Ptosis can affect one or both eyes. Ptosis can be present at birth (congenital) or develop later in life (acquired). Ptosis may be due to a myogenic, neurogenic, aponeurotic, mechanical or traumatic cause. Usually, ptosis occurs isolated, but may be associated with various other conditions, like immunological, degenerative, or hereditary disorders, tumors, or infections. Besides drooping, patients with ptosis complain about tired appearance, blurred vision, and increased tearing. Patients with significant ptosis may need to tilt their head back into a chin-up position, lift their eyelid with a finger, or raise their eyebrows. Continuous activation of the forehead and scalp muscles may additionally cause tension headache and eyestrain. If congenital ptosis is not corrected, amblyopia, leading to permanently poor vision, may develop. Patients with ptosis should be investigated clinically by an ophthalmologist and neurologist, for blood tests, X-rays, and CT/MRI scans of the brain, orbita, and thorax. Treatment of ptosis depends on age, etiology, whether one or both eyelids are involved, the severity of ptosis, the levator function, and presence of additional ophthalmologic or neurologic abnormalities. Generally, treatment of ptosis comprises a watch-and-wait policy, prosthesis, medication, or surgery. For minimal ptosis, Müller's muscle conjunctival resection or the Fasanella Servat procedure are proposed. For moderate ptosis with a levator function of 5-10 mm, shortening of the levator palpebrae or levator muscle advancement are proposed. For severe ptosis with a levator function <5 mm, a brow/frontalis suspension is indicated. Risks of ptosis surgery infrequently include infection, bleeding, over- or undercorrection, and reduced vision. Immediately after surgery, there may be temporary difficulties in completely closing the eye. Although improvement of the lid height is usually achieved, the eyelids may not appear perfectly symmetrical. In rare cases, full eyelid movement does not return. In some cases, more than one operation is required.
View
Upgaze Eyelid Position Allows Differentiation Between Congenital and Aponeurotic Blepharoptosis According to the Neurophysiology of Eyelid Retraction
Article
  • Dec 2006
To differentiate between congenital and aponeurotic blepharoptosis, we investigated whether upgaze with stretching of the mechanoreceptor of Mueller muscle increases involuntary reflex contraction of the levator slow-twitch muscle fibers. In 50 cases each of unilateral congenital blepharoptosis and of asymmetric aponeurotic blepharoptosis, the mean increases by upgaze in the upper eyelid margin to the line between the medial and lateral canthi as upper eyelid retraction distance (UERD) of the ptotic eyelid 0.4 mm and 2.9 mm, respectively. These were significantly smaller and significantly larger than those of the corresponding nonptotic eyelid, 2.0 mm and 2.3 mm, respectively.Worsening of ptosis on upgaze is common in congenital ptosis and is an abnormal differentiating sign, lacking the involuntary reflex contraction. Improvement of ptosis on upgaze is common in aponeurotic blepharoptosis and likely represents a normal physiological process, restoring the involuntary reflex contraction.
View
Predictability of ConjunctivalMüellerectomy for Blepharoptosis Repair
Article
  • Jan 2008
To assess the predictability of the algorithm used to determine the amount of tissue resection for conjunctival-Müellerectomy during blepharoptosis repair. A consecutive case series of all patients undergoing conjunctival-Müellerectomy during blepharoptosis repair between July 2001 and February 2005. All of the cases had a positive phenylephrine test, and the mean preoperative upper marginal reflex distance (MRD1) was +1.60 mm (range: -1 +/-3.5 mm). Each patient underwent excision according to the following algorithm: 10 mm of resection for 2 mm of ptosis, 8 mm of resection for 1.5 mm of ptosis, and 6 mm of resection for 1 mm of ptosis. Fifty-five patients underwent conjunctival-Müellerectomy during blepharoptosis repair on 73 eyelids, using the above algorithm. Thirty-seven cases were unilateral and 18 were bilateral. The mean postoperative MRD1 was +3.42 mm (range 0-+4.5 mm). Postoperative symmetry was found in 42 of 55 patients (76.4%) after one surgical procedure. Patient satisfaction based on contour, symmetry and height after one repair was achieved in 52 of 55 patients (94.55%). There were three reoperations for previous undercorrection. This algorithm quantifies conjunctival-Müellerectomy during blepharoptosis repair. Excellent and very predictable results are obtained by a technique that is both simple and achievable in a short operating time.
View
Cosmetic dou ble eyelid su rgery: single 5 mm-partial incision method
  • Jan 2002
  • H S Ryu
  • Ku M Is
  • K W Minn
Ryu HS, Ku m IS, Minn KW: Cosmetic dou ble eyelid su rgery: single 5 mm-partial incision method. J Korean Soc Plast Reconstr Surg 29:521, 2002
Dou ble eyelid operation with three tiny incisions
  • Jan 2000
  • Y K Kim
  • J D Kwon
  • K S Oh
Kim YK, Kwon JD, Oh KS: Dou ble eyelid operation with three tiny incisions. J Korean Soc Plast Reconstr Surg 27:195, 2000