Surgical Techniques, Outcomes, and Referral Patterns After Adult Blepharoptosis Surgery

Purpose Blepharoptosis surgery aims to restore upper eyelid position, yet the need for reoperation remains a key concern. This study aimed to evaluate residual ptosis rates, the need for reoperation, and factors influencing surgical outcomes in a high-volume ptosis referral center. Methods This retrospective study analyzed 260 adults who underwent ptosis repair (2009–2021), comparing outcomes across four techniques: Müller's Muscle-Conjunctival Resection, Levator Advancement, Fasanella-Servant, and Frontalis sling. Primary endpoints included residual ptosis (MRD1 < 2.5 mm) and reoperation rates. Results Aponeurotic ptosis was the most common subtype (85.1%), with Müller's Muscle-Conjunctival Resection being the most frequently performed technique (62.8%). Residual ptosis was observed in 25.4% of cases, yet only 18.5% underwent reoperation. Prior ocular surgery, particularly cataract extraction, was significantly associated with higher revision rates (p < 0.05), while ptosis type and surgical technique did not significantly influence outcomes (p ≥ 0.116). Conclusion Residual ptosis alone does not necessarily indicate the need for reoperation, suggesting that MRD1 may be insufficient as a standalone outcome measure. Predictors of referral for reoperation, such as prior ocular surgery, should be considered in surgical planning. Future research should incorporate patient-centered metrics beyond MRD1 to guide surgical decision-making.