Assessing outcome following levatorplasty: when east meets west editorial on paper “transcutaneous aponeurotic repair with small detachment of the levator aponeurosis for aponeurotic blepharoptosis in japanese patients”

In this well-written paper [insert reference] the authors convincingly argue for combining a long skin incision with a limited aponeurosis dissection for involutional ptosis in East Asian patients instead of the small incision, external levator repair or excision currently in vogue. This makes sense as a longer incision allows for the creation of a smooth double eyelid crease which this surgeon seems to have achieved in a high percentage (> 86%) of patients. Why less than two-thirds of patients were satisfied with the overall result, where one functional, and 3 aesthetic criteria were applied, is much harder to explain and comes as a surprise.

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