Analysis of surgical outcome after levator advancement by assessing changes in eyelid contour

Purpose: The authors analyzed changes in eyelid contour after levator advancement by measuring multiple radial midpupil lid distance (MPLD). Methods: The study enrolled 61 eyes of 61 patients with involutional ptosis who underwent levator advancement from 2 oculoplastic surgeons from September 2008 to December 2013. An analysis of upper lid contours was performed using front gaze photographs of the preoperative and postoperative states and comparing them to the front gazes of normal patients. Conventional and 12 oblique midpupil lid distances were measured every 15 degrees across the temporal (105, 120, 135, 150, 165, and 180 degrees) and nasal (75, 60, 45, 30, 15, and 0 degrees) fields of the eyelid fissure using custom software. Results: Ptosis patients had low temporal eyelid height and significantly decreased MPLD at all angles compared with normal controls. Compared with the preoperative eyelid, all MPLD angles were significantly increased after surgery, and the temporal peak height of the eyelid was recovered. Conclusions: The normal shape and temporal peak height of eyelids should be considered for levator advancement surgery with ptosis. The authors retrospectively compared postoperative changes in eyelid contour to modify the method of surgery.