To the Editor.—We would like to comment on the article by Millay and Larrabee describing the well-known technique of levator aponeurotic ptosis repair in blepharoplasty.1 In their discussion of complications the authors mention that surgery on a ptotic eyelid may result in a postoperative ptosis on the opposite side. This has also been thoroughly described previously.2-4 This phenomenon is observed in roughly 5% of ptosis cases5 and, as the authors note, is explained by Hering's law of equal innervation to the paired extraocular muscles. It usually occurs when the ptotic eyelid impinges on the visual axis of the dominant eye, and may result in either frank retraction of the opposite eyelid, if the levator muscle attachments are normal on the contralateral side, or in masking of a true ptosis, if the contralateral levator muscle is also abnormal.
This "complication," however, can usually be avoided by proper preoperative evaluation of the
KERSTEN RC, KULWIN DR. Ptosis in Blepharoplasty Surgery. Arch Otolaryngol Head Neck Surg. 1990;116(1):108-109. doi:10.1001/archotol.1990.01870010112032