Revision ptosis surgery for under-correction after Muller muscle conjunctival resection

Dear Editor-in-Chief, We wish to submit a new manuscript entitled "Revision ptosis surgery for under-correction after Muller muscle conjunctival resection" for consideration by Journal for Plastic and Reconstructive Surgery Journal. We confirm that this work is original and has not been published elsewhere nor it is currently under consideration for publication elsewhere. We read with great interest the article published by Dr Karlin and colleagues entitled “Revision ptosis surgery for under-correction after Muller muscle conjunctival resection”. By reading the article, which we truly appreciated in its being detailed and accurate, we thought to share our opinions according to our clinical experience on blepharoptosis diagnosis and surgical treatment. As known ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is often underdiagnosed and undertreated. Dr Karlin et al., with their study, compared the functional outcomes of two of the most used technique for blepharoptosis correction, Muller muscle conjunctival resection (further MMCR) and External Elevator Resection (further ELR). They used MRD-1 (upper Marginal Reflex Distance-1) as unique parameter to assess and rate the surgical success of the procedures. The evolving understanding of the condition and expanding therapeutic options, led us to propose an alternative method to evaluate post-operative MRD-1, which appears to us more reliable and precise. In specific, we believe that using the WTW (White-To-White) distance of each single patient instead of the average measurement to standardize the scale may be more accurate to obtain the “calculated” MRD1 for each patient. We believe this manuscript could be of interest to readers in the area of Plastic, Reconstructive and Aesthetic Surgery since it should allow the reader for going deeper into an apparently marginal topic, yet in our opinion interestingly complex.