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Posterior approach white line advancement ptosis repair: the evolving posterior approach to ptosis surgery
  1. Vikesh Patel,
  2. Aysha Salam,
  3. Raman Malhotra
  1. Corneoplastic Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
  1. Correspondence to Mr Raman Malhotra, Corneoplastic Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK; raman.malhotra{at}


Introduction We describe a surgical technique for ptosis correction in moderate to good levator function involving advancement of the levator aponeurosis via a transconjunctival posterior approach without resection of Müller's muscle. We present our experience of and the results from this method, and review the evolution of posterior approach ptosis surgery.

Purpose To assess the efficacy and predictability of posterior approach white line advancement ptosis repair.

Methods Retrospective analysis of all patients with primary aponeurotic ptosis undergoing posterior-approach repair using white line advancement between December 2007 and June 2008. We describe a technique whereby after dissection of the Muller's conjunctiva composite flap, the levator aponeurosis is advanced with double-armed sutures through the white line, then through the tarsus and out through the skin.

Results There were 112 ptosis procedures during this period, of which 71 eyelids of 41 patients were eligible for inclusion. There were 14 men and 27 women. The mean age was 63.76 (range 24–87) years. Minimum follow up was 3 months (range 12–43 weeks). Of the 71 procedures, 42 were combined with a blepharoplasty. Sixty-two achieved their desired lid height, contour and symmetry (87.3% success rate). No patients were overcorrected. Success rate in the phenylephrine-positive group (42/71) was 88.1% compared with 100% in phenylephrine-negative group (4/71).

Conclusions We present a modified approach to ptosis correction via a posterior approach. It has a high success rate and good cosmetic outcome. It is technically straightforward and easy to learn.

  • Aponeurotic ptosis
  • posterior approach
  • eye lids
  • treatment surgery

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  • Competing interests None

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by Queen Victoria Hospital NHS Foundation Trust.

  • Provenance and peer review Not commissioned; externally peer reviewed.