Involutional ptosis.

Involutional ptosis was corrected by either an anterior or posterior approach in 105 eyelids. The posterior approach was preferred unless there was a specific indication for the anterior approach which included excess skin and bulky eyelids. At operation approximately 10% of cases were found to have fatty degenerative changes in the anterior part of the levator muscle. These changes were associated with a relatively normal skin crease, bulky eyelids, lateral displacement of the tarsus, and a more marked ptosis in the medial part of the lid. A second procedure was required in 14 eyelids to achieve eyelid heights which remained within approximately 1 mm of each other for the follow-up period, which extended to eight years.