Background: Muller's muscle plays an important role in maintaining the position of the upper eyelid. The muscle itself has power to elevate the upper eyelid about 2 mm as showing 2 mm drooping of the upper eyelid in Horner's syndrome and the muscle is the important transmitter of the levator muscle action to the tarsal plate, so it should be preserved as much as possible in the operative procedure for blepharoptosis.

Methods: A total of 182 cases (240 eyelids) underwent advancement of the Muller's muscle-levator aponeurosis composite flap from September 1988 to December 2005 to correct mild to moderate congenital blepharoptosis with fair to good levator function and to correct mild to severe acquired blepharoptosis. Seventy-four percent (135 cases) was congenital blepharoptosis and sixty four percent (116 cases) was unilateral blepharoptosis. Follow up period was from 6 months to 18 years (average follow-up of 20 months).

Results: In operative results, 164 of 182 cases (90.1%) was restored to excellent range of the desired eyelid height in primary gaze after first operation but remaining 18 cases had minor revisions to make symmetrical and desired eyelid height. Most common complication was undercorrection of the ptosis. Conclusion: This procedure is simple and physiological procedure with no or minimal sacrifice of the Muller's muscle, yielding predictable and satisfactory results.