Prospective validation of transcutaneous levator recession for non-thyroid lid retraction: efficacy, safety, and predictable outcomes.

PURPOSE: To prospectively evaluate the efficacy and safety of transcutaneous levator aponeurosis recession for upper eyelid retraction resulting from non-thyroid etiologies and to establish surgical dose-response relationships.

METHODS

This prospective interventional case series included 29 eyes of 27 patients with upper eyelid retraction secondary to non-thyroid causes. All patients underwent transcutaneous levator aponeurosis recession by a single surgeon. Preoperative and postoperative margin reflex distance (MRD1) were assessed by two independent masked observers. Primary outcome was change in MRD1. Secondary outcomes included dose-response relationship, complications, and subgroup analysis by etiology and severity.

RESULTS

Mean follow-up was 22.4 ± 8.3 months. Mean preoperative MRD1 improved from 6.5 ± 0.8 mm to 3.9 ± 0.4 mm (p < 0.001). Mean recession amount was 12.4 ± 2.3 mm. Average recession required per 1 mm MRD1 reduction was 5.3 mm overall. Etiological analysis showed comparable dose-response in myogenic (5.2 mm) and neurogenic (5.1 mm) cases, while mechanical etiologies required greater recession (7.3 mm). Severe cases demonstrated more efficient correction (4.3 mm per 1 mm) compared to moderate cases (5.6 mm). Under-correction occurred in 2 eyes (6.9%), overcorrection in 4 eyes (13.8%). No major complications occurred.

CONCLUSION

Levator aponeurosis recession is effective and safe for non-thyroid upper eyelid retraction. The surgical dose-response appears to vary by etiology and severity, with mechanical cases tending to require more aggressive recession and severe cases showing greater efficiency. These findings provide preliminary guidance to support individualized surgical planning, while larger studies are needed to confirm and refine these trends.