Indications for the procedure of aponeurotic repair are nearly all of the ptoses that have 8 mm or more of elevation from downward to upward gaze. Such cases have a levator with an adequate striated part, an inadequate superior tarsal (Müller) muscle, and an aponeurosis that has involutional changes such as a dehiscence or disinsertion.
Local anesthesia is advised. The incision is made 7 mm above the lash-line, through the skin and pretarsal muscle only. Blunt dissection upward is used until the preaponeurotic fat pad is uncovered. The upper part of the aponeurosis is picked up under the fat pad and sutured to the lower part of the aponeurosis with 5-0 chromic gut. Fifty-seven eyelids in thirty-four patients have been operated on, with excellent results and minimal trauma.
Jones LT, Quickert MH, Wobig JL. The Cure of Ptosis by Aponeurotic Repair. Arch Ophthalmol. 1975;93(8):629-634. doi:10.1001/archopht.1975.01010020601008