Outcomes of Mild to Moderate Upper Eyelid Ptosis Correction Using Müller's Muscle-Conjunctival Resection

Background: MŸller's muscle-conjunctival resection (MMCR) is a technique used for correction of mild to moderate ptosis. This study was designed to examine the efficacy of the senior author's MMCR technique and analyze variables that potentially affect outcomes of the surgery.

Methods: Patients with ≥10-month follow-up were included. The amount of ptosis reduction, symmetry of eyelids, effects of concomitant facial aesthetic surgeries, and adverse outcomes were analyzed. Furthermore, patients were grouped into short-term follow-up (<24 months) and long-term follow-up (>24 months) cohorts to determine if the outcomes of MMCR changed over time.

Results: Forty patients with mean follow-up of 28 months combined for a total of 70 MMCR surgeries. MMCR significantly reduced ptosis by a mean 1.48mm ± 0.88mm (p<0.001), corresponding to 0.19mm of eyelid elevation for every 1.0mm of MŸller's muscle resected. MMCR successfully corrected 84% of eyelids to within 0.5mm, and 94% to within 1.0mm of normal eyelid position. MMCR significantly improved eyelid symmetry to within 0.5mm from 53% of patients before surgery to 75% of patients after (p=0.036) (Table 1). Furthermore, the mean correction of ptosis was not significantly different between short-term (1.58mm ± 0.93mm) and long-term (1.32mm ± 0.93mm) follow-up patients (p=0.258) (Table 2). Lastly, concomitant surgeries such as upper and lower blepharoplasty, rhytidectomy, and endoscopic forehead rejuvenation did not significantly affect ptosis correction by MMCR (p>0.05) (Table 3).

Conclusions: MŸller's muscle-conjunctival resection is an effective long-term solution to mild to moderate eyelid ptosis and asymmetry, and can be effectively performed concomitantly with other aesthetic facial procedures.

Table 1. Eyelid Symmetry

	Percent of Patients
	Preoperative	Postoperative	p-value
Eyelid height discrepancy ≤0.5mm	53%	75%	0.036

Table 2. Long Term vs. Short Term Follow-up

	Duration at Follow-up
	<24 months	>24 months	p-value
Number of patients (n)	23	17	-
Mean age (years)	60.4 ± 9.6	56.2 ± 13.4	0.252
Mean follow-up (months)	15.2 ± 4.2	57.2 ± 32.7	<0.0001
Mean ptosis reduction (mm)	1.58 ± 0.93	1.32 ± 0.93	0.258

Table 3. Concomitant Surgeries

	Mean Ptosis Reduction (mm)
	Case	Control	p-value
Upper blepharoplasty	1.56mm ± 0.83mm	1.38mm ± 1.04mm	0.451
Lower blepharoplasty	1.51mm ± 0.78mm	1.39mm ± 1.12mm	0.625
Rhytidectomy	1.49mm ± 0.90mm	1.40mm ± 1.06mm	0.697
Endoscopic forehead rejuvenation	1.59mm ± 0.65mm	1.42mm ± 1.02mm	0.565

Figure 1. Preoperative

Figure 2. Postoperative