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Outcomes of Mild to Moderate Upper Eyelid Ptosis Correction using Müller's Muscle-Conjunctival Resection

Mengyuan T. Liu, BS Ali Totonchi, MD Kris Katira, MD Justin Daggett, MD Bahman Guyuron, MD, FACS
Department of Plastic Surgery University Hospitals Case Western Reserve University
2012-01-31

Presenter: Kris Katira

Affidavit:
This project represents a collaborative effort. Kris Katira participated substantially in all phases of the project: background, data collection, and analysis.

Director Name: Dr. Arun Gosain

Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Aesthetics

How does this presentation meet the established conference educational objectives?
This presentation analyzes outcomes of a specific mullerectomy technique for correction of upper eyelid ptosis, a relevant topic for any plastic and reconstructive surgeon, satisfying objectives all three of the objectives.

How will your presentation be used by practicing physicians in the audience?
Any surgeon faced with the problem of upper eyelid ptosis in clinical practice can use the findings of our study to decide whether it is beneficial to use Müller's muscle-conjunctival resection (MMCR).

Background: Müller's muscle-conjunctival resection (MMCR) is a technique used for correction of mild to moderate ptosis. This study was designed to examine the efficacy of the senior author's MMCR technique and analyze variables that potentially affect outcomes of the surgery.

Methods: Forty patients met the inclusion criteria. The amount of ptosis reduction, symmetry of eyelids, effects of concomitant facial aesthetic surgeries, and adverse outcomes were analyzed. Furthermore, patients were grouped into short-term follow-up (<24 months after surgery) and long-term follow-up (>24 months) cohorts to determine if the outcomes of MMCR changed over time.

Results: Forty patients combined for a total of 70 MMCR surgeries. MMCR significantly reduced ptosis by a mean 1.48mm + 0.88mm (p<0.001), corresponding to 0.19mm of eyelid elevation for every 1.0mm of Müller's muscle resected. MMCR successfully corrected 84% of eyelids to within 0.5mm, and 94% to within 1.0mm of normal eyelid position. MMCR significantly improved eyelid symmetry to within 0.5mm from 53% of patients before surgery to 75% of patients after (p=0.036). Furthermore, the mean reduction of ptosis was not significantly different between short-term (1.58mm + 0.93mm) and long-term (1.32mm + 0.93mm) follow-up patients (p=0.258). Lastly, concomitant surgeries such as upper and lower blepharoplasty, rhytidectomy, and endoscopic forehead rejuvenation with corrugator supercilii resection did not significantly affect ptosis correction by MMCR (p>0.05).

Conclusions: Müller's muscle-conjunctival resection is an effective long-term solution to mild to moderate upper eyelid ptosis and asymmetry, and can be effectively performed concomitantly with other facial aesthetic procedures.

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