Acquired ptosis: dehiscences and disinsertions. Are they real or iatrogenic?
Acquired ptosis has previously been felt to be due to a dehiscence or disinsertion of the levator aponeurosis. In the early years of levator surgery, the aponeurosis was often exposed by using blunt dissection. We have found that with a change in surgical technique, which eliminates blunt dissection, the incidence of aponeurotic defects decreases dramatically. Dehiscence and disinsertion may therefore be caused by traumatic surgical dissection of an attenuated aponeurosis.