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Allen M Putterman, Commentary on: Modified Levator Muscle Resection Using Putterman Müller’s Muscle-Conjunctival Resection-Ptosis Clamp, Aesthetic Surgery Journal, Volume 38, Issue 5, May 2018, Pages 488–490, https://doi.org/10.1093/asj/sjx199
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The author provides an update on his previously reported technique to advance the levator aponeurosis in the correction of upper eyelid ptosis, now with a larger volume of cases.1 I compliment the author on his successful and good results.
The levator aponeurosis advancement procedure dates back to a description by Jones over 40 years ago.2 I believe the author’s contribution to this procedure is to use a clamp that I developed for the Müller muscle-conjunctival resection procedure, now used to excise the loose connective tissue between the superior tarsal border and the recessed levator aponeurosis with what he believes is a less traumatic and faster recovery time than the usual surgical resection and dissection of this tissue.3 The Müller muscle clamp was designed with a curvature of the superior blades to match the curvature of the superior tarsal border (Figure 1). I believe this adds to the successful postoperative eyelid curvature after the Müller muscle-conjunctival resection by removal of the same amount of tissue nasally, centrally, and temporally.4 This also probably explains the author’s good contour results, since he too is probably removing the same amount of tissue nasally, centrally, and temporally with the clamp.
