A new refined technique for myogenic ptosis correction with resection of myotarsal flap by conjunctival approach.

The purpose is to present a new refined surgical technique for mild-to-severe acquired myogenic ptosis correction under local anaesthesia (LA) as day cases with resection of myotarsal (MT) flap and demonstrate the safety and efficacy of the technique. MT flap consists of 2 mm tarsal strip with attached levator complex - levator muscle, its aponeurosis, and Müller muscle. This is a retrospective personal series of 400+ patients, who underwent surgical correction with MT flap resection of 8-24 mm under LA mostly as day cases. No patient had any complication. Results were satisfactory as assessed on these criteria: (i) elevation of the lid at least above the visual axis; (ii) normal contours of the lid without distortion, with the eyelid conforming to the contours of the globe; (iii) static and dynamic symmetry of upper eyelids; (iv) formation of a normal and symmetrical lid fold; (v) healthy comfortable ocular surface and cornea; and (vi) patient and surgeon satisfaction with the aesthetic outcome. Resection of the MT flap is a safe and effective, microsurgical technique of ptosis correction, yielding satisfactory results without complications, with ergonomic advantages of the inclusion of a tarsal strip. The versatility of the MT flap extends to its use for correction of upper lid retraction, and for formation of the posterior lamina of full thickness small to subtotal lower lid reconstructions.