From W Aesthetic Plastic Surgery.
Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital.
Plast Reconstr Surg. 2024 Jun 1;153(6):1403-1414. doi: 10.1097/PRS.0000000000010889. Epub 2023 Jun 27.
Upper eyelid ptosis correction is a challenging procedure. The authors report a novel approach to this procedure that is more accurate and predictable compared with conventional approaches.
A preoperative system of assessment has been formulated to more accurately estimate the amount of levator advancement required. The levator advancement was referenced from a constant landmark: the musculoaponeurotic junction of the levator palpebrae superioris. The factors considered include the amount of upper lid elevation required, the degree of compensatory brow elevation present, and eye dominance. The preoperative assessment and surgical technique are presented in a series of detailed operative videos. The levator advancement is performed as planned preoperatively with final adjustment made intraoperatively to achieve correct lid height and symmetry.
Seventy-seven patients (154 eyelids) were analyzed prospectively in this study. The authors found this approach to be reliable and accurate in predicting the required amount of levator advancement. Intraoperatively, the formula correctly predicted the exact required fixation location in 63% of eyelids, and to within ±1 mm in 86% of cases. This may be used for patients with ptosis of varying severity, ranging from mild to severe eyelid ptosis. The revision rate was 4%.
This approach is accurate in determining the fixation location needed, enabling levator advancement for ptosis correction to be performed with more precision and predictability.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
上睑下垂矫正术是一项具有挑战性的手术。作者报告了一种与传统方法相比更准确、更可预测的新方法。
制定了术前评估系统，以更准确地估计需要进行提上睑肌提升的量。提上睑肌提升的参考基准是提上睑肌的肌膜-腱膜结合部，这是一个恒定的标志点。考虑的因素包括所需的上睑提升量、存在的代偿性眉抬高程度和主导眼。术前评估和手术技术在一系列详细的手术视频中呈现。术前按照计划进行提上睑肌提升，然后在术中进行最终调整，以达到正确的眼睑高度和对称性。
本研究前瞻性分析了 77 例（154 只眼）患者。作者发现，这种方法在预测所需提上睑肌提升量方面是可靠和准确的。术中，该公式在 63%的眼睑中正确预测了确切的所需固定位置，在 86%的病例中误差在±1mm 以内。这种方法可用于不同严重程度的上睑下垂患者，从轻度到重度上睑下垂均可。手术修订率为 4%。
这种方法可准确确定所需的固定位置，使提上睑肌提升术在矫正上睑下垂时更精确、更可预测。
临床问题/证据水平：治疗性，IV。
