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Arch Aesthetic Plast Surg. 2012 Feb;18(1):1-6. Korean. Original Article.
Byun JS .
BS Aesthetic Clinic, Daegu, Korea. byunjs55@hanmail.net
Abstract

In combined techniques of a buried suture and an incision method, the eyes are opened easily with minimal effort, because the strength of the levator palpebrae muscle in the early stage of the eye opening process is firstly transmitted to the tarsal plate. The power of eye opening is efficiently transmitted without diminishing its strength. In addition, postoperative swelling on the lower flap is minimal, without loss of the power of eye opening, which allows for effective correction of ptosis in case of weak levator function. The elevation force of the upper eyelid is mainly initiated from the contraction of the levator palpebrae superioris and transmitted to the levator aponeurosis which is inserted into the anterior surface of the tarsal plate. The classical surgical procedure for bleoharoptosis is accomplished by strengthening the weak levator aponeurosis by means of levator plication, shortening, or Muller tucking procedure. The levator sheath thickens to form the superior transverse ligament of Whitnall and runs continuously inferiorly anterior to the levator aponeurosis and forms the deep layer of the orbital septum. The author has used the levator sheath to reinforce the weak levator aponeurosis effectively in cases of all ptotic eyelids. The elevation effect of the levator sheath plication is more than 1mm of the eyelid level in average and it is same effect to more than 3-4mm plication of the levator aponeurosis.

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