Levator transposition and frontalis sling procedure in severe unilateral ptosis and the paradoxically innervated levator

R. M. Dryden, J. C. Fleming and M. H. Quickert

Symmetry in severe unilateral ptosis, the jaw-winking syndrome, and ptosis with aberrant third-nerve regeneration is best achieved with bilateral frontalis suspension. However, the levator function needs to be removed in the normal side with unilateral ptosis and bilaterally with the paradoxically innervated levator. Levator transposition to the arcus marginalis is a reversible methods of establishing a complete ptosis. the reversibility of the procedure is demonstrated in the rhesus monkey. The procedure, when combined with frontalis suspension in humans, demonstrates the needed elimination of levator function.