Aponeurotic ptosis surgery.

The recognition of defects in the levator aponeurosis associated with a renewed interest in eyelid anatomy has led to a revival of aponeurotic surgery. We describe our approach with emphasis on techniques that help obtain and maintain avascular planes throughout surgery. The advantages of this approach include preservation of (1) tear-producing structures, (2) Müller's muscle and Whitnall's ligament, and (3) normal anatomical planes and structures of the eyelid. Our results indicate that this technique is the procedure of choice for acquired ptosis cases. It also gives good results in congenital ptosis cases with at least 5 mm of function. Overcorrection at surgery is necessary in all cases. Tucking of the aponeurosis is to be avoided as no raw healing surfaces are obtained. Results in 60 eyelids with a minimum follow-up of one year are presented.