The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot.

BACKGROUND: Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole. METHODS: This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021. RESULTS: In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm 2 . Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively. CONCLUSIONS: The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.

Image sensors using thin-film absorbers.

Image sensors are must-have components of most consumer electronics devices. They enable portable camera systems, which find their way into billions of devices annually. Such high volumes are possible thanks to the complementary metal-oxide semiconductor (CMOS) platform, leveraging wafer-scale manufacturing. Silicon photodiodes, at the core of CMOS image sensors, are perfectly suited to replicate human vision. Thin-film absorbers are an alternative family of photoactive materials, distinguished by the layer thickness comparable with or smaller than the wavelength of interest. They allow design of imagers with functionalities beyond Si-based sensors, such as transparency or detectivity at wavelengths above Si cutoff (e.g., short-wave infrared). Thin-film image sensors are an emerging device category. While intensive research is ongoing to achieve sufficient performance of thin-film photodetectors, to our best knowledge, there have been few complete studies on their integration into advanced systems. In this paper, we will describe several types of image sensors being developed at imec, based on organic, quantum dot, and perovskite photodiode and show their figures of merit. We also discuss the methodology for selecting the most appropriate sensor architecture (integration with thin-film transistor or CMOS). Application examples based on imec proof-of-concept sensors are demonstrated to showcase emerging use cases.

A Thin-Film Pinned-Photodiode Imager Pixel with Fully Monolithic Fabrication and beyond 1Me- Full Well Capacity.

Thin-film photodiodes (TFPD) monolithically integrated on the Si Read-Out Integrated Circuitry (ROIC) are promising imaging platforms when beyond-silicon optoelectronic properties are required. Although TFPD device performance has improved significantly, the pixel development has been limited in terms of noise characteristics compared to the Si-based image sensors. Here, a thin-film-based pinned photodiode (TF-PPD) structure is presented, showing reduced kTC noise and dark current, accompanied with a high conversion gain (CG). Indium-gallium-zinc oxide (IGZO) thin-film transistors and quantum dot photodiodes are integrated sequentially on the Si ROIC in a fully monolithic scheme with the introduction of photogate (PG) to achieve PPD operation. This PG brings not only a low noise performance, but also a high full well capacity (FWC) coming from the large capacitance of its metal-oxide-semiconductor (MOS). Hence, the FWC of the pixel is boosted up to 1.37 Me- with a 5 µm pixel pitch, which is 8.3 times larger than the FWC that the TFPD junction capacitor can store. This large FWC, along with the inherent low noise characteristics of the TF-PPD, leads to the three-digit dynamic range (DR) of 100.2 dB. Unlike a Si-based PG pixel, dark current contribution from the depleted semiconductor interfaces is limited, thanks to the wide energy band gap of the IGZO channel material used in this work. We expect that this novel 4 T pixel architecture can accelerate the deployment of monolithic TFPD imaging technology, as it has worked for CMOS Image sensors (CIS).

Analysis of Tertiary Interactions between SART3 and U6 Small Nuclear RNA Using Modified Nanocapillaries.

We employed modified glass nanocapillaries to investigate interactions between the RNA-binding protein, known as cell carcinoma antigen recognized by T cells-3 (SART3), and the noncoding spliceosome component, U6 small nuclear RNA (snRNA), at the single-molecule level. We functionalized the nanocapillaries with U6 snRNA fragments, which were hybridized to DNA molecules and then covalently attached to the nanocapillary surface. When transported through the modified nanocapillaries, two different SART3-derived constructs, HAT-RRM1-RRM2 and RRM1-RRM2, exhibited resistive ionic current pulses with different dwell times, which represented their different binding affinities to tethered U6 snRNAs. The dissociation constants (KD), estimated from the bias voltage dependence of translocation events, were approximately 1.9 µM and 201 µM for HAT-RRM1-RRM2 and RRM1-RRM2, respectively. These values were comparable to corresponding values obtained with isothermal titration calorimetry, demonstrating that the modified glass nanocapillaries are applicable to analyses of protein-ligand interactions at the single-molecule level.

Selective Detection of Single-Stranded DNA Molecules Using a Glass Nanocapillary Functionalized with DNA.

We describe glass nanocapillaries with single-stranded DNA molecules (ssDNA) covalently attached to the capillary surface. These DNA-functionalized nanocapillaries selectively facilitate the translocation of target ssDNA that is complementary to the probe ssDNA. In addition, the complementary target ssDNA exhibits an event duration time longer than that of the noncomplementary target ssDNA. The temperature dependence measurements of translocation events show that the longer duration time is a result of an interaction between probe and target ssDNA and is dependent on the base pair binding strength. These results demonstrate that single-base mismatch transport selectivity can be achieved using the DNA-functionalized nanocapillaries.

Change of Facial Asymmetry in Patients With Congenital Muscular Torticollis After Surgical Release.

BACKGROUND: A number of studies have shown that facial asymmetry improves in congenital muscular torticollis (CMT) patients after surgical release. This study confirmed the improvement in facial asymmetry, and analyzed factors that affect the change of facial asymmetry in CMT patients after surgical release by using objective and quantitative methods. METHODS: Facial asymmetry was analyzed in 60 CMT patients who underwent surgical release before 10 years of age. Horizontal and lower facial asymmetry angles (HFAA and LFAA) in the clinical photograph were used to measure facial asymmetry. Postoperative improvements in HFAA and LFAA were evaluated in each age group, after grouping the patients by age. Patients were divided into 2 groups according to the postoperative head tilt and functional deficit. Postoperative improvements in HFAA and LFAA were compared between 2 groups. The relationships between postoperative improvements in HFAA and LFAA and independent variables (age, follow-up period, preoperative HFAA or LFAA, postoperative head tilt, and postoperative functional deficit) were analyzed. RESULTS: Mean age at operation was 34.8 months (range, 6-120 mo). Horizontal facial asymmetry angle was improved significantly postoperatively in groups <5 years of age. Lower facial asymmetry angle was improved significantly postoperatively in all age groups. No significant difference was found in the postoperative improvements in HFAA and LFAA between 2 groups according to the postoperative head tilt and functional deficit. In the correlation analysis, postoperative improvements in HFAA and LFAA were proportional to the follow-up period (r = 0.256, P = 0.048) and preoperative HFAA or LFAA (r = 0.600, P < 0.001). CONCLUSIONS: Facial asymmetry in CMT patients can be improved in part if surgical release is performed before 10 years of age and the possibility of improvement may be different according to the area of the face. After surgical release, facial asymmetry will improve over a long period of time, and patients with more severe facial asymmetry have a better remodeling potential to achieve facial symmetry.

Effects of human adipose-derived stem cells and stromal vascular fraction on cryopreserved fat transfer.

BACKGROUND: The use of cryopreserved adipose tissue for soft tissue augmentation is common, but unpredictability of fat graft viability remains a limitation. Adipose-derived stem cell (ADSC) and stromal vascular fraction (SVF) have been introduced to enhance viability and improve the survival of transplanted fat tissue. OBJECTIVE: To investigate whether supplementation with ADSC or SVF improved the survival of cryopreserved fat grafts. METHODS: The cryopreserved fat grafts were treated with ADSC, SVF, or normal saline in 30 six-week-old male nude mice to test whether ADSC and SVF could improve the survival of the transplanted fat tissue. The authors examined the weight, volume, and histological features of each group (n = 10) at 8 weeks after transplantation to evaluate the survival of the fat tissue. RESULTS: There was no difference between the control and SVF groups with respect to weight, volume, and histological findings. However, the ADSC group showed a significant increase in weight and volume compared with the control and SVF groups. Histological examination showed that the ADSC supplementation improved the quality of the transplanted fat grafts. CONCLUSION: Taken together, these results suggest a potential clinical utility of ADSC but no advantage of SVF in facilitating cryopreserved fat transfer.

Successful reconstruction of irradiated anterior skull base defect using the dual flap technique involving local pericranial flap and radial forearm free flap.

Skull base reconstruction presents a challenging therapeutic problem requiring a multispecialty surgical approach and close cooperation between the neurosurgeon, head and neck surgeon, as well as plastic and reconstructive surgeon during all stages of treatment. The principal goal of skull base reconstruction is to separate the intracranial space from the nasopharyngeal and oropharyngeal cavities, creating support for the brain and providing a water-tight barrier against cerebrospinal fluid leakage and ascending infection. We present a case involving a 58-year-old man with anterior skull base defects (2.5 cm × 3 cm) secondary to the removal of olfactory neuroblastoma. The patient received conventional radiation therapy at 6000 cGy in 30 fractions approximately a month before tumor removal. The patient had radiation therapy before surgery and was planned to have postoperative radiation therapy, which would lead to a higher complication rate of reconstruction. Artificial dura was used for the packing of the dural defect, which was also suspected to increase the complication rate of reconstruction. For these reasons, we chose to apply the dual flap technique, which uses both local pericranial flap and de-epithelized radial forearm free flap for anterior skull base defect to promote wound healing. During 28 months of follow-up after coverage of the anterior skull base defect, the dual flap survived completely, as confirmed through follow-up magnetic resonance imaging. The patient was free of cerebrospinal fluid leakage, meningitis, and abscess, and there was minimal donor-site morbidity of the radial forearm free flap. Reconstruction of anterior skull base defects using the dual flap technique is safe, reliable, and associated with low morbidity, and it is ideal for irradiated wounds and low-volume defects.

Transdermal scopolamine for the treatment of recurrent parotid sialocele: a case report.

Recurrent parotid sialocele is rare and challenging to treat. Treatment options are limited for cases of parotid sialocele that recur despite ductal ligation. This case study presents a patient who underwent wide excision of the right buccal mucosa due to squamous cell carcinoma. During the wide excision, a segment of the parotid duct was excised, and ductal ligation was performed to prevent the occurrence of a sialocele, followed by reconstruction using a folded anterolateral thigh free flap. Twenty-two days after surgery, parotid sialocele occurred despite the initial ductal ligation and subsequent ductal ligation was performed; however, the sialocele recurred. As an alternative therapeutic option, a transdermal scopolamine patch was applied for 3 weeks, with one patch used every 3 days. The results were encouraging, with complete resolution of the sialocele. A transdermal scopolamine offers a noninvasive, convenient method of treating parotid sialocele with minimal side effects. The successful outcome of this case suggests that a transdermal scopolamine can be an effective therapeutic option for recurrent parotid sialocele in conjunction with surgical treatment.

Modified folding radial forearm flap in soft palate and tonsillar fossa reconstruction.

Wide excision of cancer arising from the tonsillar fossa and soft palate has several functional sequelae (e.g., speech, swallowing, chewing, and breathing) that require surgical restoration of the pharyngeo-palatal structure and optimal velopharyngeal function. For this purpose, several kinds of surgical procedures have been introduced. Our method to reconstruct the tonsillar fossa and soft palate entails folding the flaps and reconstructions at the same time as the oral and nasal planes, with some modifications.Patient 1 was a 64-year-old man with left soft palate cancer. After wide excision of the tumor, the defect size of the nasal floor was 3 × 3 cm, and that of soft palate and tonsillar fossa was 8 × 5 cm. Patient 2 was a 49-year-old man with left tonsil cancer. The defect size of the nasal floor was 3 × 3 cm, and that of left lateral wall of the tonsillar fossa was 8 × 3 cm. For reconstruction of oral, nasal, and tonsillar plane, we designed the flap fit to the defect site, especially cutting of the edge of the square plane of the flap to a round shape.Both patients achieved good functional recovery without surgical complications. The average speech intelligibility score in the 2 patients was 10. Swallowing functional score was 4 in both patients. Creative reconstruction with modified radial forearm free flap for tonsillar and soft palate area makes it possible to restore velopharyngeal function to levels close to the preoperative condition.

Significance of osteoporosis in facial bone density using computed tomography.

OBJECTIVES: The objectives of this study were to compare the variations of bone density in the midfacial bones as measured by computed tomography (CT) scans between the osteoporosis and control groups and to evaluate the regions that facial trauma and iatrogenic problem often occur in the midface. METHODS: The 96 patients who underwent both osteomeatal unit CT scans and dual-energy x-ray absorptiometry at our hospital were included in this study retrospectively. Seven skeletal regions were chosen for evaluation: group A (orbital floor, nasal bone), group B (zygomaticomaxillary suture, zygomatic arch, zygomaticofrontal suture), and group C (anterior wall of the maxillary sinus, maxillary process). Forty-seven patients were in the osteoporosis group, and 49 patients were in the control group. On a PACS (picture archiving communication system), the region of interest was analyzed, and the Hounsfield units were measured. RESULTS: There was a significant difference in the mean bone density of the midfacial bones between the osteoporosis group and the control group (P < 0.01). For both groups, each of comparison of the 7 skeletal regions was greater as group A < group B < group C in this order (P < 0.01). CONCLUSIONS: We can see the independent effects of osteoporosis on the midfacial bones using CT scans. Estimated Hounsfield unit through CT scan is able to explain osteoporosis, which may be useful in the clinical fields in the future.

Role of a fluid-restrictive strategy in flap-surgery: A single center retrospective cohort study.

In this study, we evaluated the outcomes of flap surgery and the incidence of acute kidney injury (AKI) in patients who underwent flap surgery using a fluid-restrictive strategy. We retrospectively reviewed the consecutively collected medical records of patients who underwent flap surgery using the fluid-restrictive strategy of our hospital. The patients were divided into 2 groups based on the period of flap surgery: 2011 to 2014 (initiation period of the fluid-restrictive strategy) and 2015 to 2020 (implementation period). Outcomes of flap surgery and the incidence of AKI were evaluated based on percentage changes in cumulative fluid balance to initial body weight (%FO) on post-operative day 7. A total of 140 patients were enrolled in the study; 50 (35.7%) underwent flap surgery in 2011 to 2014 and 90 (64.3%) in 2015 to 2020. In 2015 to 2020, the median %FO significantly decreased from 2.7 (interquartile range [IQR]: 0.8-7.1) to 0.1 (IQR: -2.2 to 3.4%, P < .001), whereas the success rate significantly increased from 53.3% to 70.5% (P = .048) compared to 2011 to 2014. The incidence of AKI remained unchanged. In multivariate analysis, the odds ratio for success was 2.759 (95% confidence interval: 1.140-6.679) in 2015 to 2020 compared to 2011 to 2014. After successfully implementing the fluid-restrictive strategy, the success rate of flap surgery significantly increased without any further increase in the incidence of AKI. Our experience could serve as a model for implementing a fluid-restrictive strategy in flap surgery.

Lymphaticovenular anastomosis for Morbihan disease: a case report.

Morbihan disease (MD) is a very rare condition characterized by rosaceous or erythematous lymphedema on the upper twothirds of the face. A definitive management strategy for MD is lacking, and treatment is challenging. Herein, we present a case of persistent bilateral eyelid edema treated by lymphaticovenular anastomosis (LVA) and lymph node-vein bypass surgery. The patient experienced persistent bilateral eyelid edema. Indocyanine green lymphography was performed, and the diagnosis of bilateral facial lymphedema was confirmed. On the right side, a preauricular lymphatic vessel was anastomosed to a vein. On the left side, lymphostomy on the preauricular lymph node was done, with anastomosis to the transected proximal end of the concomitant vein of the transverse facial artery. Furthermore, a preauricular lymphatic vessel was anastomosed to a vein. Eyelid edema decreased and progressively improved on both sides. The outcome of this case suggests that LVA and lymph node-vein bypass surgery are appropriate for treating persistent eyelid edema related to MD.

A multicenter, randomized, double-blind, comparative study of a multiphasic hyaluronic acid filler and existing hyaluronic acid fillers for temporary restoration of the midface volume of Asian individuals.

BACKGROUND: Giselleligne is the world's first multiphasic gel product that evenly surrounds particles. In the current study, Giselleligne was compared with other existing fillers to evaluate their clinical use, safety, and ability to improve midface volume deficits of Asian individuals. METHODS: A comparative experiment was conducted to gain an understanding of the physical properties of Giselleligne, which is a multilayered hyaluronic acid filler, and to compare its properties with those of existing hyaluronic acid fillers. The primary outcome of this study was a Midface Volume Deficit Scale (MFVDS) score improvement at 24 weeks after the procedure. The secondary outcomes were as follows: MFVDS score improvement after the procedure; MFVDS score changes after the procedure; Global Esthetic Improvement Scale (GAIS) scores as evaluated by the operator after the procedure; the operator's satisfaction with the product; evaluation of the GAIS scores by the patient after the procedure; and pain level of the patient on the day of the procedure. RESULTS: Giselleligne exhibited properties that are expected to result in significantly superior clinical outcomes compared to existing products. Giselleligne was superior not only to the existing products but also in terms of global esthetic improvement, effect duration, and operator satisfaction. Furthermore, Giselleligne was found significantly safer than the existing products. CONCLUSION: Giselleligne is a safer, more user-friendly, and more effective alternative to existing products for improving the midfacial volume.

Interface-Engineered Organic Near-Infrared Photodetector for Imaging Applications.

We report a high-speed low dark current near-infrared (NIR) organic photodetector (OPD) on a silicon substrate with amorphous indium gallium zinc oxide (a-IGZO) as the electron transport layer (ETL). In-depth understanding of the origin of dark current is obtained using an elaborate set of characterization techniques, including temperature-dependent current-voltage measurements, current-based deep-level transient spectroscopy (Q-DLTS), and transient photovoltage decay measurements. These characterization results are complemented by energy band structures deduced from ultraviolet photoelectron spectroscopy. The presence of trap states and a strong dependency of activation energy on the applied reverse bias voltage point to a dark current mechanism based on trap-assisted field-enhanced thermal emission (Poole-Frenkel emission). We significantly reduce this emission by introducing a thin interfacial layer between the donor: acceptor blend and the a-IGZO ETL and obtain a dark current as low as 125 pA/cm2 at an applied reverse bias of -1 V. Thanks to the use of high-mobility metal-oxide transport layers, a fast photo response time of 639 ns (rise) and 1497 ns (fall) is achieved, which, to the best of our knowledge, is among the fastest reported for NIR OPDs. Finally, we present an imager integrating the NIR OPD on a complementary metal oxide semiconductor read-out circuit, demonstrating the significance of the improved dark current characteristics in capturing high-quality sample images with this technology.

Infected sialocele: complication in masseter reduction using radiofrequency coagulation.

Radiofrequency coagulation was introduced to reduce the volume of masseter muscle. Radiofrequency procedure causes focal necrosis in masseter muscles, which leads to muscle hypoplasia and a slender lower face. We present a case of a 24-year-old woman who underwent radiofrequency coagulation to reduce masseter muscles. The patient experienced progressive erythematous swelling and noticed the mass around the right cheek 5 days after the procedure. On radiologic evaluation, a round cavity of 4-cm diameter containing air and fluid was observed. Incision and drainage was performed, and antibiotics were administrated intravenously. Blood-tinged purulent fluid was obtained, which was subsequently found to have a high amylase level. The swelling subsided, and there is no relapse up to 6 months after drainage. There are several complications of radiofrequency coagulation reported such as mucoserous fluid collections, late bleeding, infections, long-lasting pain, Stensen duct injury, facial nerve injuries, and limitation of temporomandibular joint movement. A well-designed operation plan and skilled technique are required to avoid these complications.

Cutaneous paraganglioma of the vertex in a child.

Paraganglioma is a neuroendocrine neoplasm that may develop at various body sites, including the head, neck, thorax, and abdomen. Approximately 85% of paragangliomas develop on the abdomen, 12% develop on the chest, and only 3% develop on the head and neck. These tumors are found in locations that parallel the sympathetic chain ganglion in the thoracolumbar regions and parasympathetic nervous system in craniosacral regions, and all head and neck paragangliomas arise from the parasympathetic nervous system. Although the skin has a rich neural network, it is devoid of ganglia. There has been only 1 report of a paraganglioma on the scalp of a child. We describe a 3-year-old child with a primary cutaneous paraganglioma of the vertex scalp and review the literature on paragangliomas.

Aesthetic blepharoptosis correction with release of fibrous web bands between the levator aponeurosis and orbital fat.

BACKGROUND: Blepharoplasty remains one of the most frequent operations in Asia. The most common complaint of Asian patients is a limitation of eye opening, and a substantial proportion of patients have puffy eyelids, supratarsal folds in the upper eyelid, and a narrow palpebral fissure, thus exhibiting a tired and sleepy appearance. To correct these features, an accurate understanding of upper eyelid anatomy is essential, especially concerning the levator aponeurosis, orbital fat, and orbital septum. METHODS: After a strip of orbicularis oculi muscle was removed through usual transcutaneous blepharoplasty incision, we excised the submuscular soft tissue to expose the fusion line of the septum and the levator aponeurosis. Blunt dissection was carried out between the levator aponeurosis and the orbital fat. During dissection, a three-dimensional fibrous web connecting the orbital fat and levator aponeurosis, and continuing to just behind the Whitnall ligament, was observed in all patients. All of the connections with these fibrous bands were resected during the procedure using a Steven scissors while controlling bleeding. After this dissection, we reevaluated the degree of blepharoptosis in the upright position and checked the function of the levator palpebral muscle. We observed that mild and subclinical blepharoptosis was corrected without manipulation of the levator aponeurosis or the Müller muscle. RESULTS: Of the 32 patients evaluated, 22 were women and 10 were men. All of our patients had mild or subclinical blepharoptosis (<2 mm). The levator function was excellent or good in all patients. Most of these patients (29/32, 87.5%) were satisfied with the outcome after this operation. CONCLUSIONS: The authors found that fibrous web bands between levator aponeurosis and orbital fat limit movement of the levator aponeurosis, which is a cause of eye opening limitation. In the current study, subclinical and mild blepharoptoses were corrected by releasing these fibrous bands without manipulating the levator aponeurosis or the Müller muscle. This method has been shown to be highly effective in correcting mild ptosis and can be applied during most surgical blepharoptosis techniques.

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center.

This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient's arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery (P = .847) and 1 month (P = .336), 3 months (P = .630), and 6 months after surgery (P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery (P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.

Blepharoptosis correction: repositioning the levator aponeurosis.

Blepharoplasty remains one of the most popular surgical procedures in Asia. The most common patient complaint leading to a blepharoplasty is limited eye opening causing a narrowing of the palpebral fissure. The typical Asian eye is characterized by puffiness, lack of a supratarsal fold in the upper eyelid, and a narrow palpebral fissure, exhibiting a tired and sleepy appearance. Almost all such patients believe that a simple double-eyelid operation is able to make the eye look bigger with eversion of the eyelashes into a more charming configuration. Some of these patients actually have mild to moderate blepharoptosis, which can present both functional and aesthetic problems. Numerous surgical procedures have been developed to correct ptosis because proper correction can be difficult to achieve. The authors found abnormal lateral deviation of the levator aponeurosis in patients with blepharoptosis and suggest that this abnormality is a major cause of blepharoptosis, particularly in Asians. The authors assessed the effectiveness of a levator aponeurosis medial repositioning technique rather than levator resection or levator plication for mild or moderate ptosis. No disadvantage was attributed to this technique when it was used to correct 87 patients with mild ptosis. Eighty of the 87 patients achieved a good result with the first operation. Undercorrection was observed in 6 patients, and a hematoma was corrected in 1 patient. However, no other major complications related to the technique were encountered. Herein the authors describe their operative technique and present the long-term follow-up results. The authors propose that anatomic repositioning of a laterally deviated levator aponeurosis using the described repositioning technique is highly effective for correcting mild ptosis and can be applied during most surgical blepharoptosis procedures in Asian patients.