Stabilization of eyelid height after aponeurotic ptosis repair

Objective: To develop guidelines for revision of ptosis surgery in the earl y postoperative period by establishing what percentage of eyelids after ant erior levator advancement have reached their final height by the first post operative week. Design: Prospective noncomparative case series. Participants: An analysis was performed on 164 eyelids in 97 patients with involutional aponeurotic ptosis. intervention: Anterior levator advancement was performed on each of these 164 eyelids, Exclusion criterion consisted of a history or evidence of neurologic or muscular disease, preceding traum a, an anophthalmic socket, or prior eyelid surgery. Main Outcome Measures: The marginal reflex distance, eyelid excursion, and degree of swelling were recorded perioperatively; additionally, photographs were obtained before surgery and at 1 and 6 weeks after surgery. Results: At 1 week after surgery, only 40% of eyelids had reached their fin al height; 52% continued to rise a mean of 1.1 mm, The percentage of eyelid s continuing to rise after the first postoperative week varied with the amo unt of swelling present at 1 week, although a direct correlation did not ex ist (Pearson correlation, 0.22; P < 0.26). Although this increase ranged fr om 0.5 to 3.0 mm for 71% of eyelids, the subsequent increase was 1 mm or le ss. Maximal eyelid height was achieved almost universally by 6 weeks, after which 18% of eyelids subsequently dropped a mean of 0.8 mm. Conclusions: Based on this study, the authors suggest revision at 1 week af ter anterior levator advancements in which minimal-to-moderate eyelid swell ing exists for contour abnormalities, if the eyelid height is 0.5 mm or mor e above or more than 1.0 mm below the target height, or if asymmetry betwee n the eyelids is 1.0 mm or more. The authors do not advise early revision f or patients with excessive swelling still present 1 week after surgery.