MODIFIED LEVATOR APONEUROTIC ADVANCEMENT WITH DELAYED POSTOPERATIVE OFFICE REVISION

The results of a ''modified'' levator aponeurotic advancement were rev iewed to determine the appropriate indications and optimum timing for office revision after blepharoptosis repair, The levator advancement w as modified as follows: 1) elimination of epinephrine from the local a nesthetic so as not to stimulate the Muller muscle, 2) use of a 6-0 si lk rather than a monofilament nonabsorbable suture to secure the advan ced levator to avoid possible cheese-wiring and late recurrence, and 3 ) excision of a strip of preseptal orbicularis muscle just above the t arsal border to create surgically apposed ''raw'' surfaces for a firm attachment of the ''advanced'' levator. Office adjustments were delaye d for at least 8 days after surgery and were performed as late as 14 d ays after surgery. Of the 122 consecutive aponeurotic advancements in 110 patients (12 bilateral cases), five (4.1%) patients were candidate s for revision in that the operated eyelid was greater than I mm from desired height. All such eyelids were undercorrected by 2.0 mm to 2.5 mm. Four of the five underwent revision at 8, 11, and 14 days (two pat ients) after surgery. The fifth patient did not undergo revision. Four patients with overcorrections from 2.0 mm to 2.5 mm resolved with eye lid massage. It is concluded that the number of office revisions may b e reduced if delayed for at least 8 days after surgery. This delay all ows for resolution of postoperative edema and objective prediction of final eyelid position. The advantages of this ''modified'' levator adv ancement procedure are discussed.