Double-eyelid blepharoplasty incorporating blepharoptosis surgery for 'latent' aponeurotic ptosis

Most of the patients who undergo double-eyelid blepharoplasty report satisfactory cosmetic results. However, it remains some complications such as the failure to create double-eyelid skin creases and the outcome of higher skin creases and asymmetrical upper eyelids. These complications may happen even when the surgery proceeded successfully and the septum was intact, which suggested that the aponeurosis could not been damaged. Between January 2008 and June 2009, 39 patients (51 eyes, 7.75%) who requested double-eyelid blepharoplasty were found to display 'latent' aponeurotic ptosis. In these patients, the aponeuroses were disinserted from the tarsus or attenuated and elongated. All of these patients agreed to undergo aponeurotic ptosis correction along with double-eyelid surgery, of which 34 (45 eyes, 88.24%) were deemed successful. We believe that the careful measurement of ptosis in cosmetic patients will help to identify patients with 'latent' aponeurotic ptosis. Incorporation of the aponeurotic reinsertion and minimal dissection into the blepharoptosis surgery will correct the 'latent' aponeurotic ptosis successfully. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.