What Is Blepharoptosis Surgery and How Is It Done?

Blepharoptosis correction surgery is one of the methods used to correct ptosis of the upper eyelid. The specific steps include preoperative marking, traction suture placement, anesthetic injection, threading, eyelid reduction, tendon sheath incision, muscle locking, orbital septum severance, continued dissection, separation of the tendon sheath and ligament, suture tightening, excision of excess skin, and skin suturing. This surgery is primarily performed by surgically opening the upper eyelid, separating and removing partial tissues, and then suturing them to shorten the upper eyelid. After blepharoptosis correction surgery, there is no recurrence, rebound, or sagging, mainly because the surgery changes the tissue of the levator palpebrae superioris muscle, and this change is permanent and irreversible.

The general operational flow is as follows:

1. Preoperative marking: First, mark the upper eyelid fold of the surgical eye. The arc and distance from the eyelid margin of the upper eyelid fold of the surgical eye should be consistent with the contralateral healthy eye. If there is no upper eyelid fold in the contralateral healthy eye, an upper eyelid fold shaping surgery consistent with the surgical eye should be performed at the same time.

2. Placement of traction sutures: Place traction sutures at the intersection of the middle and outer 1/3 and the middle and inner 1/3 of the eyelid margin using 1-0 sutures. Flip the upper eyelid to expose the superior conjunctival fornix.

3. Injection of anesthetic: Inject anesthetic under the conjunctiva of the fornix to provide anesthesia and separate part of the muscle from the conjunctiva of the fornix. The needle should be inserted shallowly during injection.

4. Threading: Make a 5mm longitudinal incision in the conjunctiva of the inner and outer fornix. Use a blunt-tipped scissors to separate the conjunctiva of the fornix from the Müller's muscle, insert a rubber band, and pull it out through the incision in the conjunctiva of the inner fornix.

5. Eyelid reduction: Reduce the eyelid by making an incision at the skin marking line (3-5mm from the eyelid margin), cutting through the skin and subcutaneous tissue to reach the tarsal plate. Use scissors to separate the orbicularis oculi muscle on the tarsal plate until the full length of the tarsal plate and the attached levator palpebrae superioris aponeurosis are exposed.

6. Incision of the tendon sheath: Make a longitudinal incision in the tendon sheath above the upper edge of the tarsal plate near the lateral canthus.

7. Locking the muscle: Use a muscle clamp to clamp the Müller's muscle, levator palpebrae superioris aponeurosis, and orbital septum, and lock the muscle in place.

8. Severance of the orbital septum: Sever the orbital septum, levator palpebrae superioris aponeurosis, and Müller's muscle between the upper edge of the tarsal plate and the muscle clamp, and pull out the exposed rubber band.

9. Continued dissection: Continue to dissect upward in front of the tendon sheath and below the Müller's muscle, severing the outer and inner corners.

10. Separation of the tendon sheath and ligament: Separate the tendon sheath from the ligament by dissecting upward in front of the tendon sheath to expose the eye ligament. Pull down the muscle clamp to test the muscle elasticity. Make three sutures 2mm above the planned levator palpebrae superioris severance line, tie them individually, and sever the levator palpebrae superioris along the predetermined severance line using a straight scissors.

11. Finally, tighten the sutures, trim excess skin, and suture the skin. If the palpebral fissure is incompletely closed, use a 0-gauge suture to make a Frost suture near the lower eyelid margin to close the palpebral fissure and fix the suture to the forehead with tape. Apply antibiotic ointment to the conjunctival sac and bandage the eye.