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Comparison of Revision Rates of Anterior- and Posterior-Approach Ptosis Surgery

A Retrospective Review of 1519 Cases

Chou, Eva M.D.*,†; Liu, Jun Ph.D.; Seaworth, Cathleen B.A.*; Furst, Meredith B.A.*; Amato, Malena M. M.D.*; Blaydon, Sean M. M.D.*; Durairaj, Vikram D. M.D.*; Nakra, Tanuj M.D.*; Shore, John W. M.D.*

Ophthalmic Plastic & Reconstructive Surgery: May/June 2018 - Volume 34 - Issue 3 - p 246–253
doi: 10.1097/IOP.0000000000000938
Original Investigations

Purpose: To compare revision rates for ptosis surgery between posterior-approach and anterior-approach ptosis repair techniques.

Methods: This is the retrospective, consecutive cohort study. All patients undergoing ptosis surgery at a high-volume oculofacial plastic surgery practice over a 4-year period. A retrospective chart review was conducted of all patients undergoing posterior-approach and anterior-approach ptosis surgery for all etiologies of ptosis between 2011 and 2014. Etiology of ptosis, concurrent oculofacial surgeries, revision, and complications were analyzed. The main outcome measure is the ptosis revision rate.

Results: A total of 1519 patients were included in this study. The mean age was 63 ± 15.4 years. A total of 1056 (70%) of patients were female, 1451 (95%) had involutional ptosis, and 1129 (74.3%) had concurrent upper blepharoplasty. Five hundred thirteen (33.8%) underwent posterior-approach ptosis repair, and 1006 (66.2%) underwent anterior-approach ptosis repair. The degree of ptosis was greater in the anterior-approach ptosis repair group. The overall revision rate for all patients was 8.7%. Of the posterior group, 6.8% required ptosis revision; of the anterior group, 9.5% required revision surgery. The main reason for ptosis revision surgery was undercorrection of one or both eyelids. Concurrent brow lifting was associated with a decreased, but not statistically significant, rate of revision surgery. Patients who underwent unilateral ptosis surgery had a 5.1% rate of Hering’s phenomenon requiring ptosis repair in the contralateral eyelid. Multivariable logistic regression for predictive factors show that, when adjusted for gender and concurrent blepharoplasty, the revision rate in anterior-approach ptosis surgery is higher than posterior-approach ptosis surgery (odds ratio = 2.08; p = 0.002).

Conclusions: The overall revision rate in patients undergoing ptosis repair via posterior-approach or anterior-approach techniques is 8.7%. There is a statistically higher rate of revision with anterior-approach ptosis repair.

Of 1519 consecutive patients undergoing ptosis repair of all etiologies from all age groups, the overall ptosis revision rate was 8.7%, 6.8% in the posterior-approach ptosis group and 9.5% in the anterior-approach ptosis group.

*TOC Eye and Face, Austin, Texas

Ophthalmic Plastic and Reconstructive Surgery, Ophthalmology Service, Department of Surgery, Walter Reed National Military Medical Center Bethesda, Bethesda, Maryland

Department of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A.

Accepted for publication April 11, 2017.

Preliminary results from this data were presented at the Fall ASOPRS Scientific Symposium on October 16–17, 2014 in Chicago, IL.

The authors have no financial or conflicts of interest to disclose.

The opinions expressed in this article are the author’s own and do not reflect the view of the Department of Navy, Department of Defense, or the United States government.

Address correspondence and reprint requests to John W. Shore, M.D., TOC Eye and Face, 3705 Medical Parkway, Suite 120, Austin, TX 78705. E-mail:


© 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.