# Refinement of maximal levator resection for blepharoptosis correction: High incision and advancement of levator complex

## TL;DR

A new surgical technique called HIAL is introduced to improve blepharoptosis correction with better outcomes and fewer complications.

## Contribution

The HIAL technique introduces a modified approach to maximal levator resection for severe blepharoptosis.

## Key findings

- HIAL significantly improved palpebral fissure height and levator function in pediatric patients.
- All patients showed favorable aesthetic outcomes with no recurrence.
- Seven out of nine patients achieved excellent functional results.

## Abstract

Maximal levator resection (MLR) is indicated for severe blepharoptosis with poor levator function (LF) but carries risks of intraoperative bleeding due to dissection above the tarsus, conjunctival perforation, and postoperative conjunctival prolapse. To address these issues, we introduce the High Incision and Advancement of Levator Complex (HIAL) technique, designed to optimizing functional and aesthetics outcomes while minimizing complications.

This study evaluates the effectiveness of HIAL technique in reducing surgical complications in severe congenital blepharoptosis.

Nine pediatric patients with congenital severe blepharoptosis underwent HIAL procedure. The levator complex was dissected 8–10 mm above the superior tarsal border and extended toward Whitnall’s ligament to create a 10 × 5 mm rectangular flap, which was then advanced and secured to the tarsus.

The mean levator resection measured 24.67 ± 0.87 mm. Postoperative outcomes demonstrated significant improvements in palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), and LF (all p < 0.05). Functionally, seven patients achieved excellent outcomes, and two demonstrated good results, with all exhibiting favorable aesthetics and no recurrence.

The HIAL technique may represent a feasible and potentially effective option for managing severe blepharoptosis with poor LF, providing both functional and aesthetic benefits while reducing surgical complications.