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External Levator Advancement versus Müller Muscle–Conjunctival Resection for Aponeurotic Blepharoptosis: A Randomized Clinical Trial

Saonanon, Preamjit M.D.; Sithanon, Supapan M.D.

Plastic and Reconstructive Surgery: February 2018 - Volume 141 - Issue 2 - p 213e-219e
doi: 10.1097/PRS.0000000000004063
Cosmetic: Original Articles
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Background: The purpose of this study was to compare the efficacy of external levator advancement and Müller muscle–conjunctival resection in aponeurotic blepharoptosis repair.

Methods: Mild to moderate blepharoptosis patients with good levator function and a positive phenylephrine test were randomized to upper blepharoplasty with either external levator advancement or Müller muscle–conjunctival resection. The primary outcome was marginal reflex distance 1 at 1 month after surgery. Secondary outcomes were cosmetic outcome, complications, and operating room time.

Results: Forty patients were enrolled, six men and 34 women, with an average age of 62.4 years. The mean preoperative marginal reflex distance 1 in the levator group (39 eyes/20 subjects) and the Müller group (38 eyes/20 subjects) was 1.2 ± 0.8 mm and 1.5 ± 0.7 mm, respectively. The mean postoperative marginal reflex distance 1 in the levator and Müller groups was 3.0 ± 1.0 mm and 3.2 ± 1.0 mm, respectively. The difference in the mean change was 0.008, and was not statistically different (95 percent CI, −0.59 to 0.61; p = 0.978). The mean cosmetic outcome was 2.69 ± 0.81 for the levator group and 3.07 ± 0.68 for the Müller group, with a mean difference of 0.373 (95 percent CI, 0.06 to 0.69; p = 0.020). The average operating room time was 75 ± 19.2 minutes for the levator group and 71 ± 23.6 minutes for the Müller group (p = 0.439). There were four eyes that underwent reoperation, three in the levator group (7.7 percent) and one in the Müller group (2.6 percent).

Conclusions: External elevator advancement and Müller muscle–conjunctival resection are both effective in correction of mild to moderate blepharoptosis. However, Müller muscle–conjunctival resection yields a statistically significant better cosmetic outcome and causes less eyelid asymmetry.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Bangkok, Thailand

From the Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society.

Received for publication April 1, 2017; accepted August 29, 2017.

Presented at the American Academy of Ophthalmology 2016 Annual Meeting, in Chicago, Illinois, October 15 through 18, 2016.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Preamjit Saonanon, M.D., 1873, Rama 4 Road, Pathumwan, Bangkok10330, Thailand, psaonanon@gmail.com

Copyright © 2018 by the American Society of Plastic Surgeons