KMID : 1037220150210020031
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Archives of Aesthetic Plastic Surgery 2015 Volume.21 No. 2 p.31 ~ p.36
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Various Modifications of Muller¡¯s Muscle-Conjunctival Resection for Ptosis Repair
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Liao Shu-Lang
Chuang Ann Yi-chiun
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Abstract
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Background: The posterior approach for ptosis, including the Fasanella-Servat procedure and Muller¡¯s muscle-conjunctival resection (MMCR), has been proven effective for mild- to moderately affected patients whose levator muscle function remains relatively intact. Traditionally, MMCR was reserved for phenylephrine test-positive patients for whom various modifications and several nomograms have been developed.
Methods: We reviewed the literature for the Fasanella-Servat procedure and MMCR. The methods and results of the different modifications were analyzed and compared. Nomograms of these two procedures were summarized.
Results: MMCR mainly involved resection of Muller¡¯s muscle and conjunctiva in the original design by Putterman and co-workers. The suggested resection ranged from 8 to 9 mm for the achievement of the maximal effect produced by topical epinephrine. Perry included tarsectomy in his procedure and developed a new nomogram that included a 1:1 ratio of the ptosis correction to the amount of tarsus resection. The effect of tarsectomy for the Fasanella-Servat procedure in terms of eyelid elevation was approximately one-half the value seen in phenylephrine test-negative patients. We¡¯ve performed MMCR with tarsectomy regardless of the response to phenylephrine with similar results to Perry. Surgical indications and possible complications of MMCR with tarsectomy for Asian patients are discussed.
Conclusions: MMCR is an effective and simple method for the correction of ptosis. With baseline MMCR, the additional tarsectomy has proven to be a powerful tool for ptosis correction irrespective of phenylephrine test results.
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KEYWORD
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Blepharoplasty, Blepharoptosis
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