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The Sutureless Mullerectomy

Gildener-Leapman, Juliana R.*; Sheps, Iyar*; Stein, Ran*; Benyamini, Oren*; Milstein, Asher; Hartstein, Morris E.*

Ophthalmic Plastic & Reconstructive Surgery: May/June 2019 - Volume 35 - Issue 3 - p 290–293
doi: 10.1097/IOP.0000000000001331
Surgical Techniques

Purpose: Müller’s muscle-conjunctival resection (MMCR) is a well-known approach for ptosis repair. In its standard fashion, it involves resection of Müller’s muscle and conjunctiva, followed by suturing of the conjunctiva and Müller’s muscle to the tarsus with absorbable or nonabsorbable sutures. The authors herein present their experience in performing MMCR without sutures.

Methods: The study was conducted as a retrospective review of 19 patients (34 eyelids) undergoing sutureless MMCR. Thirty-three eyelids had acquired ptosis and 1 eyelid had congenital ptosis. Surgery consisted of a standard approach and placement of a Putterman clamp. Following excision of the clamped tissues, no internal sutures were placed. Preoperative and postoperative upper margin-to-reflex distances were measured and patients were evaluated for symmetry within 1 mm and the incidence of any complications.

Results: Nineteen patients underwent 34 sutureless MMCR procedures. Of these, 13 patients had bilateral ptosis repair. Thirty-three of 34 eyelids (97%) showed improvement in margin-to-reflex distances, with an average improvement of 1.4 mm (range, 0–3.5 mm, SD = 0.64) among all patients. Eighteen of the 19 patients (94.7%) showed postoperative symmetry of margin-to-reflex distances within 1 mm (p < 0.001, χ2 test). One patient who underwent unilateral surgery demonstrated a Herring’s response postoperatively, leading to the single case of asymmetry. There was 1 case of corneal abrasion seen postoperatively.

Conclusions: The sutureless technique is a rapid and effective method for performing MMCR. This technique is especially useful as an adjunct to blepharoplasty where mild ptosis exists for an added rejuvenating effect. It is low-risk and potentially corneoprotective when compared to the standard suture technique. Further studies could determine if a modified algorithm needs to be applied.

This study demonstrates a technique for a sutureless conjunctival mullerectomy and the efficacy and safety of this procedure.

*Division of Ophthalmic Plastic and Reconstructive Surgery, Department of Ophthalmology and Visual Sciences, Yitzhak Shamir Medical Center, Sackler School of Medicine, Tel Aviv University, Tzrifin, Israel

Department of Ophthalmology, Kaplan Medical Center, Hebrew University Medical School, Rehovot, Israel.

Accepted for publication January 10, 2019.

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

Presented in video format at the ASOPRS conference in Chicago on October 2018.

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Address correspondence and reprint requests to Juliana R. Gildener-Leapman, M.D. E-mail:

© 2019 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.