Comparison of levator resection and frontalis muscle transfer in the treatment of severe blepharoptosis

Background: The optimal surgical approach for blepharoptosis is dependent upon many factors, the most important being levator function. However, the preferred approach in severe blepharoptosis remains a matter of contention. Methods: We investigated 130 patients with levator function between 2 and 4 mm who underwent corrective surgery for blepharoptosis between January 1990 and December 2004. There were 65 eyelids of levator resection performed in 50 patients and 105 eyelids of frontalis transfer performed in 80 patients. Postoperative results were evaluated, with an average follow-up period of 27 months. Results: The average preoperative degree of ptosis was approximately 2.7 mm in cases treated with levator resection and 4.0 mm in cases treated with frontalis muscle transfer. The average postoperative level of ptosis was approximately 1.7 mm in levator resection and 2.1 mm in frontalis muscle transfer. The average degree of postoperative ptosis improvement was approximately 1.0 mm in levator resection and approximately 1.86 mm in frontalis muscle transfer. The most frequent complication of levator resection was undercorrection. Eyelid deformity due to excessive traction was more frequent in the frontalis muscle flap technique. Conclusion: Levator resection and frontalis transfer can effectively treat blepharoptosis patients with poor levator function. Frontalis muscle transfer should be performed more carefully in operation to avoid complications which too excessive contraction could cause for blepharoptosis patients with 2 similar to 4 mm of levator function. Also, some accessorial methods were regarded as necessary to prevent undercorrection in performing levator resection.