I developed orbital approach for the LPS advancement in 2004. Since then the advanced levator has been fixed to the anterior surface of the tarsal plate. It meant making an opening through the Muller muscle and thus reaching the tarsal plate. Recently I started to fix LPS to Muller muscle itself, instead of the tarsal place. The main anchorage was at the LPS level, while the tying suture was merely passed under the Muller muscle. There could be an element of cheese wiring in this approach. Now I have reversed the anchoring = the initial anchoring is on the Muller muscle. The LPS does not need that kind of anchoring, since it is surrounded by strong connective tissue of orbital septum. The operation offers more confidence to the surgeon. The surgery time is much less now. Postoperative recovery is near immediate.
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