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Page 4 of 12 Laplant et al. Plast Aesthet Res 2020;7:60 I http://dx.doi.org/10.20517/2347-9264.2020.69
Figure 2. The upper eyelid is everted using a Desmares retractor and the desired resection is measured using calipers
Figure 3. A 6-0 black silk suture is placed to mark the site
Figure 4. The 6-0 silk suture is tented up and the Putterman Muller’s muscle-conjunctival resection clamp is placed
transconjunctival aponeurotic surgery without Müller’s muscle resection, and transconjunctival levator
plication [37-41] .
MMCR
In traditional MMCR surgery a Desmares retractor is used to evert the lid and expose the posterior surface
[Figure 2]. A predetermined amount of Müller’s muscle and conjunctiva is measured and a marking suture
is placed at this distance from the superior border of the upper tarsus [Figure 3]. A Putterman clamp (Bausch
and Lomb, Storz, Manchester, MO) is placed containing the Müller’s muscle and conjunctiva, and a running
mattress suture is placed below the clamp in a temporal to nasal direction [Figures 4 and 5]. The tissue
