Refinement of maximal levator resection for blepharoptosis correction: High incision and advancement of levator complex

Background: Maximal levator resection (MLR) is indicated for severe blepharoptosis with poor levator function (LF) but carries risks of intraoperative bleeding due to dissection above the tarsus, conjunctival perforation, and postoperative conjunctival prolapse. To address these issues, we introduce the High Incision and Advancement of Levator Complex (HIAL) technique, designed to optimizing functional and aesthetics outcomes while minimizing complications. Objectives: This study evaluates the effectiveness of HIAL technique in reducing surgical complications in severe congenital blepharoptosis. Methods: Nine pediatric patients with congenital severe blepharoptosis underwent HIAL procedure. The levator complex was dissected 8-10 mm above the superior tarsal border and extended toward Whitnall's ligament to create a 10 × 5 mm rectangular flap, which was then advanced and secured to the tarsus. Results: < 0.05). Functionally, seven patients achieved excellent outcomes, and two demonstrated good results, with all exhibiting favorable aesthetics and no recurrence. Conclusions: The HIAL technique may represent a feasible and potentially effective option for managing severe blepharoptosis with poor LF, providing both functional and aesthetic benefits while reducing surgical complications.