PURPOSE: Although many surgical procedures such as levator resection, aponeurosis surgery, Muller muscle tucking are available to correct mild and moderate blepharoptosis, the unpredictable result including undercorrection or overcorrection, recurrence and asymmetrical eyelid is still obstacles to overcome. This presentation is to introduce our new Muller muscle-levator aponeurosis advancement procedure to create aesthetically pleasing Oriental upper eyelid and to correct blepharoptosis effectively. METHODS: One hundred eighty-two patients(240 eyelids) underwent Muller muscle-levator aponeurosis advancement to correct mild to moderate ptosis in Koreans from 1985 to 2004. Through the blepharoplasty incision, the orbital septum is incised and orbital fat is removed to expose the levator aponeurosis. Muller muscle is dissected from the conjunctiva by a small conjunctival incision at the lateral, superior side of tarsal plate. Muller muscle-levator aponeurosis flap are advanced on the anterior surface of tarsal plate as composite flap. Muller muscle-levator aponeurosis composite flap are fixed approximately 2 mm below to the upper margin of tarsal plate with two 5-0 black silk horizontal mattress sutures. The amount of the advancement depends on the degree of ptosis of patients. The remnant of the composite flap is trimmed off with scissors. Trimming is less than 10 mm. Our procedure is simultaneously combined with double eyelid operation. The superior tarsal fixation suture is placed at a few mm below the upper border of tarsal plate to create a softer and supple lid crease with three to five 7-0 black buried nylon sutures. The position of the affected lid margin was adjusted at the same level with the normal side in unilateral ptosis and 1-2 mm below the superior limbus in bilateral ptosis. RESULTS: The postoperative results were evaluated according to the criteria of Souther and Jordan. The majority of patients recorded as satisfactory results and few complications in our series. However, there were 10 cases(15 eyelids) of early adjustment at 1 week of surgery and 8 cases(13 eyelids) of late reoperation at 6 months after surgery to treat undercorrection or overcorrection and asymmetrical eyelid CONCLUSIONS: We believe that our technique is very reliable and allows the construction of a more even, smooth, and symmetrical lid in case of Oriental blepharoptosis patients. Muller muscle-levator aponeurosis composite flap procedure can have better predictable result than aponeurosis surgery or Muller muscle tucking in mild or moderate ptosis because it provide not only tightening of Muller muscle and levator aponeurosis but also firm fixation to the tarsal plate.

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