23.1 Introduction

A modified Fasanella–Servat procedure has been described by Samimi, Erb, Lane, and Dresner to correct small to medium amounts of ptosis in patients with normal levator excursion (>10 mm). ¹ This procedure has fallen out of favor in recent years because of complications that include contour abnormalities, corneal abrasions, and the inability to grade the resections with an accurate nomogram. A modified Fasanella–Servat procedure has been described by Samimi et al. ² The modified Fasanella–Servat eliminates the use of two hemostats as originally described and utilizes a Putterman clamp or a modified Putterman clamp, such as the Dresner/Uzcategui clamp (Fig. 23.1). The use of these clamps minimizes the chance of contour abnormalities. A 6–0 Prolene pullout suture is also utilized instead of a plain gut suture to minimize the possibility of corneal abrasions. A nomogram has been described that accurately guides the surgeon on the amount of resection necessary for the amount of ptosis present: for every 1 mm of ptosis, 2 mm of tarsus is resected along with the accompanying Müller’s muscle and conjunctiva. ²

23.2 Indications

The Fasanella–Servat procedure is an excellent procedure for between 1 and 2.5 mm of ptosis in patients with normal levator excursion, normal eyelid contour, and a negative phenylephrine test. The Müller’s muscle–conjunctival resection procedure is preferable in patients with minimal to moderate ptosis with a positive phenylephrine test. In patients with a negative phenylephrine test, this procedure is ideal. It is also useful in patients undercorrected after Müller’s muscle–conjunctival resection or external levator repair. It can be combined with upper blepharoplasty.

23.3 Risks

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  Overcorrection.

  
  
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  Undercorrection.

  
  
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  Corneal abrasion.

  
  
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  Bleeding.

23.4 Benefits

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  Predictable amount of eyelid lift.

  
  
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  Easily performed in office setting with minimal patient discomfort.

  
  
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  Excellent option as a second procedure to correct residual ptosis after external levator advancement or Müller’s muscle–conjunctival resection.

23.5 Informed Consent

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  Include risks and benefits.

23.6 Contraindications

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  Severe dry eye and exposure keratopathy may lead the surgeon to do a smaller eyelid elevation.