Mullerlectomy (also known as Müller’s muscle-conjunctival resection) is a surgical procedure used to treat ptosis (drooping of the eyelid), especially in patients with mild to moderate ptosis who still have good levator function.

Principle of Mullerlectomy

• The Müller’s muscle is a smooth muscle located behind the levator muscle. Its function is to lift the eyelid by about 1-2 millimeters, depending on the stimulation of the sympathetic nervous system.

• In patients with ptosis who still respond to the phenylephrine test (2.5% phenylephrine instillation in the eye and the eyelid lifts well), the Müller’s muscle is considered to still be functioning well, and Mullerlectomy usually has a good outcome.

Steps of Mullerlectomy

1. Preoperative preparation:

• Perform a phenylephrine test to assess the patient’s response to surgery.

• Plan the amount of tissue to be removed to achieve the appropriate level of eyelid lift.

2. Surgery:

• Make an incision on the inside of the eyelid. (conjunctival approach) without external wound

• Cut the conjunctiva and Müller's muscle tissue to the calculated length

• Suture with absorbable suture

3. Surgery time: Approximately 20-30 minutes under local anesthesia or local anesthesia with sedation

Indications

• Mild to moderate ptosis with response to phenylephrine test

• Patients with good levator function (normal ≥10 mm)

• Patients who want a procedure without external wounds and fast recovery

Advantages of Mullerlectomy

1. No external wounds (scarless surgery)

2. Fast recovery

3. Good predictable results in patients who pass the phenylephrine test

4. The procedure usually does not take long

Disadvantages or limitations

1. Not suitable for severe ptosis or patients with poor levator function

2. Patients who do not respond to the phenylephrine test may not have good results

3. There may be a risk of overcorrection or undercorrection

Complications

1. Overcorrection (too high eyelid)

2. Undercorrection (not enough eyelid)

3. Temporary eye irritation

4. Dry eye in some cases

Mullerlectomy is a procedure suitable for patients with ptosis who have appropriate conditions, giving good results and fast recovery. It should be performed by a doctor who is an expert in oculoplastic surgery for accurate results and reducing the risk of complications.

Watch the clip on the technique for correcting weak eye muscles using the Müller’s Muscle-Conjunctival Resection (MMCR) Blepharoptosis Repair method at

Watch the clip on the technique for correcting weak eye muscles using the Müller’s Muscle-Conjunctival Resection (MMCR) Blepharoptosis Repair method at https://www.youtube.com/watch?v=2iZMt6FXPcQ