Algorithm-Based Levator Aponeurectomy

To the Editor We read with great interest the article titled "Role of algorithm-based levator aponeurectomy in small-incision external ptosis surgery for involutional ptosis" by Repp et al. The authors clearly described a new surgical algorithm for treatment of involutional ptosis considering the biomechanical property of the superior levator complex. Aponeurotic ptosis is the most common type of acquired ptosis, resulting from involutional changes of the levator aponeurosis as a consequence of its gradual stretching or attenuation of its strength. We congratulate Repp et al for the new technique proposed to control the aponeurosis to standardize the amount of stress placed on it among different patients. The algorithm is very interesting because it allows calculation of the amount of aponeurosis resection needed, minimizing the variable depending on the operator, and thus standardizing the method of surgical correction.