{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T16:33:26Z","timestamp":1793118806401,"version":"4.5.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["113-2314-B-037-088-MY3"],"award-info":[{"award-number":["113-2314-B-037-088-MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH114-4R33"],"award-info":[{"award-number":["KMUH114-4R33"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Childhood Burn Foundation of the Republic of China"},{"DOI":"10.13039\/501100004694","name":"Kaohsiung Medical University","doi-asserted-by":"publisher","award":["ST-ST114019"],"award-info":[{"award-number":["ST-ST114019"]}],"id":[{"id":"10.13039\/501100004694","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Blepharoptosis correction often relies on established levator aponeurosis (LA) plication formulas, yet their applicability across all clinical scenarios remains uncertain. Fatty degeneration of the LA may significantly alter surgical response. This study analyzes ptosis cases stratified by four grades of fatty infiltration to evaluate the adequacy of existing formulas and identify when modification is necessary.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study included 100 eyelids from 51 patients undergoing levator aponeurosis (LA) plication for upper eyelid ptosis. The cohort mostly comprised acquired aponeurotic ptosis, alongside a few congenital and mechanical cases treated with the same LA plication approach. Cases treated with frontalis-orbicularis oculi muscle (FOOM) flap or simple resection were excluded. Preoperative MRD1, ptosis grade, and levator function (LF) were recorded. Intraoperative LA fatty degeneration was graded using standardized photography, with plication adjustments made accordingly. Statistical analysis was performed using SPSS version 30.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort comprised 51 Taiwanese patients (100 eyelids), all of whom were of Asian ethnicity, with a mean age of 48.1 \u00b1 15.7 years; 88 eyelids (88.0%) were from female patients and 12 (12.0%) from male patients. The mean preoperative MRD1 was 1.80 \u00b1 1.29 mm, corresponding to a mean ptosis severity of 2.20 mm (defined as 4 - MRD1), and the mean LF was 9.97 \u00b1 2.97 mm. Among conventional formulas, the 2n + 2 algorithm showed the best calibration (mean absolute error 1.68 mm; \u00b1\u20091 mm accuracy 57%). Fatty degeneration grades 1\u20133 showed no significant deviation from predicted outcomes, whereas grade 4 required greater advancement. A simplified two-level model (grades 1\u20133: 2n + 2; grade 4: 3n) improved overall accuracy to 58% and increased \u00b11 mm accuracy in grade 4 cases from 66.7 to 83.3%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A two-level model algorithm incorporating intraoperative fatty-degeneration grading may help refine traditional levator-plication planning, maintaining simplicity while improving predictability and symmetry in severe aponeurotic ptosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence IV<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-06369-y","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:44:38Z","timestamp":1791827078000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refining Levator Plication Formulas for Ptosis Surgery in Asian Patients: Impact of Fatty Degeneration in Levator Aponeurosis"],"prefix":"10.1007","author":[{"given":"Chen-Yu","family":"Ho","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Hua","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Wen","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Shen","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2903-1703","authenticated-orcid":false,"given":"Shu-Hung","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"3","key":"6369_CR1","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1007\/s00266-003-0127-5","volume":"27","author":"J Finsterer","year":"2003","unstructured":"Finsterer J. 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Written informed consent was obtained from all patients for surgical procedures, photographic documentation, and publication of clinical photographs.","order":2,"name":"Ethics","label":"Ethical Approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}