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Supramaximal Levator Resection for Poor Function Congenital Ptosis

Bernardini, Francesco P. M.D.

Ophthalmic Plastic & Reconstructive Surgery: September/October 2019 - Volume 35 - Issue 5 - p e126
doi: 10.1097/IOP.0000000000001341
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Oculoplastica Bernardini, Genova, Milano, Roma e Torino, Italy

Accepted for publication January 19, 2019.

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

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

The video (see Video, Supplemental Digital Content 1, available at demonstrates the technique previously described in the report by Cruz et al. for correction of poor levator function (<4 mm) congenital ptosis.1 Supramaximal levator resection refers to resection of the muscle above the Whitnall ligament. The amount of resection is based on the severity of the ptosis and the measured levator function: the more severe the ptosis and poorer the levator function, the more muscle resection required. The end-point of the surgery is to have the eyelid margin rest 1 to 2 mm below the super limbus with the patient under general anesthesia. In the author’s practice, supra-maximal levator resection has become the procedure of choice for unilateral, poor levator function congenital ptosis.

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1. Cruz AA, Akaishi PM, Mendonça AK, et al. Supramaximal levator resection for unilateral congenital ptosis: cosmetic and functional results. Ophthalmic Plast Reconstr Surg 2014;30:366–71.
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