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Laplant et al. Plast Aesthet Res 2020;7:60 Plastic and
DOI: 10.20517/2347-9264.2020.69 Aesthetic Research

Review Open Access

Ptosis repair: external levator advancement vs.
Müller’s muscle-conjunctiva resection - techniques

and modifications

Jacquelyn F. Laplant , Julia Y. Kang , Kimberly P. Cockerham 2,3
2
1
1 Department of Ophthalmology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
2 Central Valley Eye Medical Group, Stockton, CA 95207, USA.
3 Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA 94303, USA.

Correspondence to: Dr. Kimberly P. Cockerham, Central Valley Eye Medical Group, 36 W Yokuts, Stockton, CA 95207, USA.
E-mail: cockerhammd@gmail.com

How to cite this article: Laplant JF, Kang JY, Cockerham KP. Ptosis repair: external levator advancement vs. Müller’s muscle-
conjunctiva resection - techniques and modifications. Plast Aesthet Res 2020;7:60.
http://dx.doi.org/10.20517/2347-9264.2020.69
Received: 6 Apr 2020 First Decision: 24 Aug 2020 Revised: 7 Sep 2020 Accepted: 21 Oct 2020 Published: 6 Nov 2020

Academic Editor: Raúl González-García Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Surgical techniques for ptosis repair continue to evolve as we gain a better understanding of the anatomy
and physiology of the eyelid. External repair by levator advancement and internal repair by Müller’s muscle-
conjunctiva resection are the most established surgical techniques used for acquired ptosis today. Controversy
over their relative indications, advantages, and disadvantages exist. The advent of new surgical techniques and
modifications has further complicated traditional algorithms that guide a surgeon towards choosing an external vs.
internal approach. Specifically, the use and interpretation of pre-operative phenylephrine testing has recently been
challenged. The purpose of this study is to review the evolution of external and internal ptosis repair techniques,
and current trends in pre-operative evaluation and surgical management of acquired ptosis.

Keywords: Blepharoptosis, ptosis, levator advancement, Müller’s muscle-conjunctiva resection

INTRODUCTION
Blepharoptosis is one of the most commonly encountered eyelid disorders in ophthalmology. Management
is primarily surgical; however, certain etiologies may improve with non-surgical management and

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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