Ptosis Repair in Aesthetic Surgery

Cosmetic ptosis is a ptosis where the upper eyelid margin is 1–2 mm below the upper corneal limbus. It is a common finding in oculoplastic practice, it does not affect the upper visual fields, and may be overlooked by patients. Both Hering’s phenomenon and eye dominance may affect eyelid positioning after ptosis repair. Proprioception in the upper eyelid may also have a role in eyebrow elevation in patients with ptosis. The most common procedures to correct ptosis together with upper eyelid dermatochalasis are Müller’s muscle-conjunctival resection (MMCR) and anterior approach levator aponeurosis advancement (LAA). MMCR tends to be more accurate for mild ptosis, and it usually provides a very good upper eyelid contour and a greater level of symmetry, being highly predictable. The cosmetic oculoplastic surgeon appropriately designs the surgery to address not only ptosis correction but the whole upper eyelid/eyebrow complex as a single unit.