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Surgical Pearls |

Upper Eyelid Blepharoplasty With Ptosis Repair by Levator Aponeurectomy

John J. Martin Jr, MD, PA1
[+] Author Affiliations
1Private practice
JAMA Facial Plast Surg. 2015;17(3):224-225. doi:10.1001/jamafacial.2015.0198.
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In a busy cosmetic surgery practice, upper eyelid blepharoplasty will be one of the most frequently performed surgical procedures performed. Often, the patient will also have a ptosis of the upper eyelid, and this must be addressed at the same time. An upper eyelid is considered to have functional ptosis when the upper eyelid margin rests 2.5 mm or less from the center of the pupil.1,2 The most common form of ptosis is involutional, in which an attenuated aponeurosis results in a drooping of the upper eyelid.3 This type of ptosis is characterized by good levator function (≥12 mm), a high eyelid crease (>10 mm), and thinning of the eyelid tissue so that the iris color can occasionally be seen through the eyelid.4

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Figure 1.
Surgical Procedure

A, Rectangle of aponeurosis marked over tarsus in a 2:1 ratio of millimeters of excision to desired millimeters of elevation. B, Edge of aponeurosis advanced and sutured to distal aponeurosis.

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Figure 2.
Aponeurosis Resection

A, Schematic representation of rectangle of aponeurosis excised. B, Schematic of aponeurosis advanced inferiorly and hooked to distal aponeurosis fibers.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Aponeurosis Repair

Modified technique for aponeurosis repair.

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