Algorithm-Based Levator Aponeurectomy—Reply

In Reply We thank Innocenti et al for their comment on our article. Although we do agree that long-term follow-up is necessary to establish the longevity of each procedure, there is no consensus in the literature regarding the necessary minimum follow-up time for upper-eyelid ptosis repair procedures. Several prior published reports of ptosis repair techniques have had similar or less follow-up time compared with our study. In addition, Doxanas did not notice late recurrences of ptosis at 3 or more years after surgery. Frueh et al suggested that late recurrences may be related to the use of dissolvable sutures to repair or advance the aponeurosis. We use nondissolving sutures. In the study by Innocenti et al, it is unclear what type of sutures was used. In addition, it is unclear if their 7.5% recurrence rate represented late recurrences or if the failures occurred earlier and remained stable at 3 years. Using dissolvable sutures, Tucker and Verhulst noted stabilization of height in most eyelids at 6 weeks after surgery.