Keywords

Minimally invasive ptosis surgery offers many advantages—a less visible scar, a reduced surgical time, and an improved postoperative period—and it is as effective and reliable as the traditional surgical approach. I have been delighted with the minimally invasive approach in aponeurogenic ptosis.

Mini-invasive Ptosis Surgery

When dealing with a patient affected by aponeurogenic ptosis, where an upper eyelid blepharoplasty is not required and the levator function is normal (i.e., >12 mm), I make a 1-cm incision in the eyelid crease and perform a routine levator advancement through that minimal skin incision. What makes this procedure very fast is the simple exposure of the orbital septum after opening the orbicularis muscle (Fig. 186.1). With the surgeon holding the superior skin/orbicularis edge apart with one rake retractor in one hand, the orbital septum can be identified by gently moving the rake up toward the brow with minimal dissection in the suborbicularis plane. After opening the orbital septum, the dissection is carried between the levator aponeurosis and the fat so that the aponeurosis and levator muscle will be clearly visualized (Fig. 186.2). A single suture between the tarsal plate and the aponeurosis will give an excellent contour in the vast majority of cases. A slight overcorrection of 1–2 mm is required to achieve an optimal final result, and two or three individual sutures are used to close the skin (Fig. 186.3). The technique requires an injection of a very small amount of local anesthesia in the eyelid (<1 ml), limiting its impact on the eyelid position; in my hands the procedure takes usually 8–10 min at most, and postoperative swelling and bruising are also greatly reduced.

Fig. 186.1
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Exposure of the septum

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Fig. 186.2
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Exposure of the pre-aponeurotic fat and levator aponeurosis

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Fig. 186.3
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Final intraoperative aspect

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