Management of the blepharoplasty patient with ptosis.

Patients who request correction of both dermatochalasis and acquired blepharoptosis require separate evaluation of each condition. The blepharoplasty is done in the standard way, depending on the amount of skin redundancy and fat herniation. The method of ptosis repair is dependent on whether Müller's muscle or levator aponeurosis is weak, the degree of ptosis and levator function, and the position of the upper eyelid crease. A tarsal Müller's muscle resection is employed in cases where the ptosis is minimal, the upper eyelid crease is normal, or the phenylephrine test is positive. A levator advancement is done if the ptosis is due to a levator aponeurosis dehiscence or attenuation with a higher than normal upper eyelid crease and thinning of the eyelid. Both procedures are easily combined with an upper eyelid blepharoplasty.