In combined techniques of a buried suture and an incision method, the eyes are opened easily with
minimal effort, because the strength of the levator palpebrae muscle in the early stage of the eye
opening process is firstly transmitted to the tarsal plate. The power of eye opening is efficiently
transmitted without diminishing its strength. In addition, postoperative swelling on the lower flap is
minimal, without loss of the power of eye opening, which allows for effective correction of ptosis in
case of weak levator function. The elevation force of the upper eyelid is mainly initiated from the
contraction of the levator palpebrae superioris and transmitted to the levator aponeurosis which is
inserted into the anterior surface of the tarsal plate. The classical surgical procedure for bleoharoptosis
is accomplished by strengthening the weak levator aponeurosis by means of levator plication,
shortening, or Müller tucking procedure. The levator sheath thickens to form the superior transverse
ligament of Whitnall and runs continuously inferiorly anterior to the levator aponeurosis and forms the
deep layer of the orbital septum. The author has used the levator sheath to reinforce the weak levator
aponeurosis effectively in cases of all ptotic eyelids. The elevation effect of the levator sheath
plication is more than 1 mm of the eyelid level in average and it is same effect to more than 3-4mm
plication of the levator aponeurosis.