The History of Ptosis Surgery

A.J. Cohen and D.A. Weinberg (eds.), Evaluation and Management of Blepharoptosis, DOI 10.1007/978-0-387-92855-5_2, © Springer Science+Business Media, LLC 2011 Abstract From an inexact origin of trial and error, blepharoptosis surgery has become a scientific art. The arc of its technical development parallels that of anatomical discoveries and surgical materials. Approaches have varied, as have the tissues of interest, and with increasingly reliable results in the reconstructive domain came greater expectations and the development of its cosmetic counterpart. That said, for some diseases associated with blepharoptosis, an ideal surgery remains elusive. This chapter provides a chronological account of the treatment of blepharoptosis with attention paid to the tissues involved. The rich history of blepharoptosis surgery provides a fertile matrix for the field of oculofacial plastic surgery, and in return, the field continues to evolve blepharoptosis’ surgical treatment. The history and evolution of eyelid ptosis surgery can be analyzed in terms of chronology and tissue. A discussion of its chronology is inviting because this method allows for an understanding of the field’s consecutive advances. One is able to appreciate the “who, what, when,” and in some cases, the more complex questions of “why” and “how” of a particular technique and understand its ultimate favor or disfavor. In a chronological discussion, one may see the subject matter’s natural arch, which unfortunately, can be confusing at times. On the other hand, a discussion of the tissues involved in eyelid ptosis surgery allows for an artificially coherent history by abstracting the salient subject matter from its historical context and ignoring the tempo of evolution. Such abstraction dispossess the matter of elements potentially useful to those responsible for the next generation of surgical innovations. Authors on the history of ptosis surgery tend to use one approach or the other. Beard used the tissue approach in his writing on the history of ptosis surgery [1, 2]. Servat and Mantilla and Thaller and Collin, as well as Julius Hirschberg, chose the chronological approach [3–5]. In this chapter, the latter approach is utilized with sensitivity paid to the tissues involved and the intention of providing the best attributes of both methods. According to Rycroft and commonly cited in historical accounts of ptosis surgery, “ancient Arabian ophthalmologists” provide the first reference of eyelid surgery for the treatment of ptosis [1–3, 6]. In what amounted to a blepharoplasty, the “ ancient Arabian” procedure involved resecting from the medial part of the upper lid an ellipse of skin that varied in size as a function of the amount of ptosis present. Others claim that about 100 ad, the encyclopedist of Greek and Roman surgery, Aulus Cornelius Celsus first documented the resection of eyelid skin for the treatment of ptosis in De Re Medica [7]. On the contrary, Hirschberg argues that neither did Celsus invent a blepharoplasty nor is Chapter 2 The History of Ptosis Surgery