Two main surgical approaches exist to raise a droopy eyelid. The first approach, known as levator advancement repair, is achieved through a skin incision on the eyelid crease. In this operation, done with local anesthesia, the surgeon identifies the weakened levator muscle and reattaches it to the eyelid plate. Many surgeons consider this approach more anatomical and precise. However, it requires the patient’s cooperation during the surgery and is challenging to obtain in anxious or sedated patients. Also, this approach may slightly alter the eyelid contour.
The alternate approach consists of shortening the conjunctiva on the eyelid’s backside along with partial resection of the Müller’s muscle. This operation is called Conjunctiva and Müller’s Muscle Resection, or CMMR. CMMR has several advantages over levator repair:
- It does not require patient cooperation, so it is ideal for patients under sedation or general anesthesia.
- CMMR is more precise because the surgeon relies on formulas that predict the amount of tissue that must be resected to achieve the desired outcome.
- CMMR achieves a more natural eyelid contour.
Unfortunately, CMMR is not for everyone. It is ideal for cases of mild ptosis, where the patient responds to phenylephrine drops.
In summary, both ptosis repair approaches have pros and cons. In general, levator advancement is better for moderate to severe ptosis and patients who can cooperate with local anesthesia. Müller’s muscle resection is an excellent alternative for mild ptosis cases and those who respond to the phenylephrine test.
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