Transconjunctival Levator Aponeurosis Advancement without Resection of Müller’s Muscle in Aponeurotic Ptosis Repair

Akihiro Ichinose*, 1, Igal Leibovitch 2
1 Department of Plastic Surgery, Kobe University. 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
2 Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel

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© Ichinose and Leibovitch; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Plastic Surgery, Kobe University, 7-5-2 Kusunoki-machi, Chuo-ku, Kobe, Hyogo 650-0017, Japan; Tel: +81-78-382-6251; Fax: +81-78-382-6269; E-mail:


The transconjunctival levator aponeurosis advancement without resection of Müller’s muscle enables repair of aponeurotic ptosis without the need for surgical exposure through a skin incision. This technique may be preferred by many patients who are reluctant to undergo ptosis surgery because of the possible skin scar and who do not present with excessive upper eyelid laxity. A successful outcome requires careful patients' selection, familiarity with the surgical anatomy of the everted eyelid, as well as with the possible complications. Special consideration should be given to factors such as determining the degree of aponeurosis advancement to accord with the height of the eyelid during surgery and to creating the desired shape and size of the “double eyelid” in Asians. From our experience, this surgical technique is effective in correcting levator aponeurotic ptosis and contributes to a quick recovery of the normal anatomy and function of the eyelid. This method should therefore be added to the arsenal of techniques for blepharoptosis repair.

Keywords: Aponeurotic ptosis, transconjunctival levator aponeurosis repair, Müller’s muscle.