The treatment of severe ptosis with poor levator function is primarily based on incorporating the vector force of the frontalis muscle to the tarsus via a facia lata graft or silicone sling. In the past few years, several surgeons have attempted to advance the frontalis flap muscle directly to the tarsus, eliminating the need for a graft. Even though it's not yet a standard procedure, many variants have recently been described, with the goal of improving the aesthetic and functional results. One such modification is adding the levator-Müller to the frontalis flap to reinforce and redirect the vertical vector force of the frontalis flap. This video will demonstrate the surgical technique of combined levator-Müller flap to the frontalis flap via a single skin incision to correct severe congenital ptosis.

This video was noted as being one of the Best of AAO 2023.