Frontalis Muscle Flap or Levator Resection for the Correction of Recurred Blepharoptosis

Park, Dae Hwan; Lee, Seung Jaee; Song, Chul Hong

Abstract

The challenge of accurately predicting eyelid height without recurrence after blepharptosis surgery is a well-known problem even in competent hands. The authors had experienced 24 recurred blepharoptosis cases from March 1999 to Feburuary 2004. 17 cases were unilateral recurred cases and the remains were bilateral cases. Previous methods in recurrent cases are as follows; Levator aponeurosis plication(2 cases), Levator resection(7 cases), Frontalis sling(15 cases). The period from first operation to secondary revision are between about 6 months to 25 years and mean period is about 6 years. The authors had managed recurrent cases with frontalis muscle advancement flap technique in 13 recurrent cases which had poor levator function or in case of frontalis muscle flap was already used. Levator resection was addressed in 11 cases which reserved levator function of more than 3mm. In Frontalis muscle flap case, the authors fixed superior-based frontalis muscle flap to tarsal plate through tunnel which was made with orbicularis oculi muscle. Among Levator resection cases, 8 cases were delayed correction cases and another 3 cases were immediate revision cases within 2 weeks after correction operation. The majority of our series recorded as satisfactory results. But, three of them gained undercorrection in follow-up period. Except for lid edema, troublesome complication just like exposure keratitis, corneal erosion was not observed. It can be safely suggested from our study that frontalis muscle advancement flap and levator resection are reasonable options in the correction of moderate to severe recurrent blepharptosis cases and the choice of recurred case management method should be accordance with levator function of patient and previously used techniques.