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Campbell et al. Plast Aesthet Res 2020;7:12 Plastic and
DOI: 10.20517/2347-9264.2019.59 Aesthetic Research

Original Article Open Access

The “central six” of ptosis repair: eliminating
contour as a variable in external levator surgery

Benjamin C. Campbell 1,2,3 , Susuana T. Adjei , William R. Nunery 1,2,3 , H. B. Harold Lee 1,2,3
1,3
1 Oculofacial Plastic and Orbital Surgery, Indianapolis, IN 46280, USA.
2 Ascension St. Vincent Hospital, Indianapolis, IN 46260, USA.
3 Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46290, USA.
Correspondence to: Dr. H. B. Harold Lee, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN
46290, USA. E-mail: huibae@gmail.com
How to cite this article: Campbell BC, Adjei ST, Nunery WR, Lee HBH. The “central six” of ptosis repair: eliminating contour as a
variable in external levator surgery. Plast Aesthet Res 2020;7:12. http://dx.doi.org/10.20517/2347-9264.2019.59
Received: 26 Nov 2019 First Decision: 4 Feb 2020 Revised: 8 Feb 2020 Accepted: 26 Feb 2020 Published: 13 Mar 2020

Science Editor: Chau Pham Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Abstract

Aim: Eyelid contour is a key component to satisfactory lid position and appearance following ptosis repair, the
components of which have been highly debated and remain difficult to objectively measure. We sought to minimize
the number of intraoperative adjustments required and reduce reoperation rates by addressing only the central
6 mm of tarsus when reapproximating levator to the anterior surface of tarsus, thereby eliminating contour as an
adjustable variable.

Methods: All patients who underwent external levator resection with blepharoplasty for correction of involutional
ptosis between 2012 and 2019 by a single surgeon at one center were retrospectively reviewed. Patients who
underwent concomitant brow lifting surgery were excluded. The same technique was used for each eyelid with
uniform suture placement. One 6-0 silk horizontal mattress suture was placed partial thickness through the
superior third of tarsus 3 mm lateral to the center of tarsus; another was passed 3 mm medial to the center of
tarsus. No sutures were placed outside of this central 6-mm zone. Patient fixation was used to determine lid height
and symmetry. Once satisfactory, the sutures were tied down in a permanent fashion and the eyelid position again
verified. In total, 153 eyelids in 85 patients were evaluated. Data obtained included preoperative and postoperative
margin-to-reflex distance (MRD ), intraoperative and postoperative complications, reoperation rates, and patient
1
satisfaction with appearance of lid contour and symmetry.

Results: The mean follow up time was 3.41 months. The mean preoperative MRD was 1.05 mm. The mean post-
1
operative was 3.18 mm. All patients had recovery of an anatomically normal temporal peak height. Two of 153
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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