Reply: Levator Advancement Surgery with or without Lateral Horn Incision: Effect of Lateral Horn Incision for Severe Involutional Blepharoptosis

My colleagues and I thank Drs. Wang and Lai for their interest in our recent article, entitled “Levator Advancement Surgery with or without Lateral Horn Incision: Effect of Lateral Horn Incision for Severe Involutional Blepharoptosis.”1 We acknowledge that individual variations in pathophysiology, tissue compliance, and eyelid anatomy should be considered in surgical planning for blepharoptosis. We agree with Drs. Wang and Lai that tissue elasticity is reduced in severe involutional blepharoptosis due to fibrosis and fatty infiltration, resulting in impaired eyelid elevation. We believe that this tissue elasticity in the upper eyelid correlates with the levator function in each patient. However, it is difficult to quantify the elasticity in upper eyelids, and few studies have examined the tissue elasticity in blepharoptosis. More investigations of the upper eyelid from the viewpoints of both pathology and biomechanics are necessary to elucidate the underlying mechanisms of blepharoptosis. DISCLOSURE The author has no financial interest to declare in relation to the content of this communication.