Treatment of mild and moderate congenital ptosis via the levator imbrication technique

Background:To correct mild and moderate congenital ptosis,traditional surgical techniques usually include dissection of the Müller’s muscle.Meanwhile,both the levator palpebrae superioris and the Müller’s muscle play a synergistic role to elevate the upper eyelid.Thus,to protect the Müller muscle and minimize injury,we developed and applied a levator imbrication technique in patients with mild and moderate congenital ptosis and followed it up to evaluate its clinical efficacy.Methods:This retrospective case series included 53 patients with mild and moderate congenital ptosis,all of whom had undergone ptosis correction using the levator imbrication technique at the Plastic and Aesthetic Department of the Second Affiliated Hospital of Zhengzhou University between June 2018 and June 2020.The outcomes of correction,upper eyelid appearance,and operative complications were observed and analyzed.The postoperative follow-up was 3–12 months.Results:Fifty cases of ptosis were fully corrected,and the bilateral double eyelids were smooth and natural.The eyelids of 20 patients were incompletely closed immediately after the operation but were able to close spontaneously within 2 weeks.No serious complications such as exposure keratitis were reported.Three patients with undercorrection underwent reoperation 3 months after the first operation,and ptosis was corrected.Conclusion:The levator imbrication technique for mild and moderate congenital ptosis is simple to perform and shortens the operation time with less damage,stable postoperative outcomes,and no long-term complications.

Morbihan disease misdiagnosed as senile blepharoptosis and successfully treated with short-term minocycline and ketotifen: A case report

BACKGROUND Morbihan disease is a rare skin condition with diagnostic and therapeutic challenges.Facial nonpitting erythematous edema is usually considered to be a characteristic manifestation and diagnostic clue for the Morbihan disease.Treatment of Morbihan disease remains a dilemma due to its long course,poor response,and high recurrence rate.CASE SUMMARY We report the case of a 69-year-old man with Morbihan disease.The patient presented ptosis as the first and main symptom.There was no obvious edema or other skin lesions.The patient was misdiagnosed with senile blepharoptosis based on eyelid performance and no treatment was administered to him.After continuous progressive asthenia of eye-opening and ptosis for more than one year,a skin biopsy was recommended.Histopathological analysis showed edema in the dermis,lymphatic hyperplasia and dilatation,and perivascular lymphocytic infiltration.An obvious increase in toluidine blue-stained mast cells was observed.The patient was finally diagnosed with Morbihan disease.Minocycline and ketotifen were prescribed based on the increase of mast cells in skin tissue slices.The patient experienced rapid relief seven days later and complete remission after 40 d from the commencement of the treatment.CONCLUSION Ptosis without obvious swelling could be the only or main clinical manifestation of Morbihan disease in rare conditions.An increase of mast cells was an important therapeutic clue to the rapid and remarkable efficiency of the combination therapy of minocycline and antihistamine.

A new technique of monsplasty as an adjunctive procedure in cases of abdominoplasty:A prospective clinical trial

Background:No standard monsplasty technique has existed until now.Although various monsplasty methods have been described,they exhibit high complication rates with sparse postoperative data.Studies that used pubic suspension techniques did not describe exact anatomical landmarks for the mons pexy.This study aimed to improve the aesthetic and functional appearance of the pubic region with long-term results for all grades of pubic ptosis or bulging with abdominoplasty and provide exact anatomical points to anchor the mons to the rectus sheath.Methods:This non-randomized prospective clinical trial included 30 patients with various degrees of abdominal wall laxity between December 2017 and September 2019.The surgical procedure was performed for female patients with pendulous abdomen,pubic ptosis or bulging,body mass index≤35 kg/m^(2),and age 18–60 years.All patients were followed for up to one year;patient satisfaction was assessed before and after surgery regarding aesthetic results and impact on outfits,hygiene,and sexual activity.Results:The marginal homogeneity test revealed a statistically significant patient satisfaction rate regarding outfits,sexual function,hygiene,and aesthetics.Regarding postoperative complications,seroma(one case)was managed by aspiration,and one case of wound dehiscence was managed conservatively with dressings.Conclusion:This study recommends a quick and reproducible monsplasty technique with a low complication rate,a technique that helps determine specific anatomical landmarks for anchoring the mons to the rectus sheath.Combining this technique with abdominal contouring is advisable for optimal aesthetic results and maintained lymphatic drainage in the pubic region.

Effects of congenital ptosis on the refractive development of eye and vision in children

AIM:To investigate the influence of unilateral congenital ptosis on the development of the eye and vision in children.METHODS:In this prospective observational study,41 patients with unilateral congenital ptosis were enrolled(age range 3-15y).The blepharoptosis was divided into 3 subgroups according to the margin reflex distance-1(MRD-1),including mild group(MRD-1>2 mm),moderate group(0<MRD-1<2 mm),and severe group(MRD-1<0 mm).The fellow eyes served as controls.All subjects underwent ocular examinations,including axial length,keratometry,and refractive error.RESULTS:The incidence of astigmatism(ptotic eyes:58.5%vs fellow eyes:24.4%,P=0.002)and magnitude of cylindrical power(ptotic eyes:-0.86±0.79 D vs fellow eyes:-0.43±0.63 D,P=0.003)differed significantly between the ptotic eyes and the fellow eyes.The spherical equivalent refraction(P=0.006),spherical power(P=0.01),cylindrical power(P=0.011),axial length-corneal radius(AL/CR)ratio(P=0.009),frequency of hyperopia(P=0.002)and astigmatism(P=0.004)were significantly different among the ptotic eye subgroups and the fellow eye group.In addition,in patients with congenital ptosis,the incidence of amblyopia is 43.9%and the incidence of anisometropia is 24.4%.More importantly,the ratio of AL/CR showed significantly positive correlation with the severity of ptosis(P=0.002).CONCLUSION:Congenital ptosis may lead to a delayed eyeball development in the aspect of AL/CR.The risk of amblyopia is also increased due to visual deprivation and aggravated anisometropia,particularly in severe ptosis case.

Prevalence of amblyopia in congenital blepharoptosis: a systematic review and Meta-analysis

AIM: To conduct a systematic review and Meta-analysis of the published literature to evaluate the pooled prevalence rate of amblyopia in patients with congenital ptosis.METHODS: We searched the PubMed, Embase, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP databases for studies reporting the prevalence of amblyopia in patients with congenital ptosis. The reference lists of relevant studies were scanned. Heterogeneity of effect sizes across studies was tested. We calculated prevalence ratios to compare prevalence estimates for different causes of amblyopia in patients with congenital ptosis, as well as for different geographical regions, year of publication and sample size in subgroup analyses. A systematic review and Meta-analysis were performed.RESULTS: We identified 29 eligible surveys with a total population of 2436. Prevalence rates of amblyopia ranged from 13.8% to 69%. We noted substantial heterogeneity in prevalence estimates for amblyopia in congenital ptosis(Cochran’s χ2 significant at P<0.0001; I2=90%). The pooled prevalence using random-effects models of 29 studies was 32.8%(95%CI: 27.3%-38.4%) in the overall population. Compared to the overall pooled prevalence, amblyopia prevalence was higher in studies in which only subjects with blepharophimosis syndrome were included.CONCLUSION: We confirm that nearly one-third of congenital ptosis patients are suffering from or at risk for amblyopia. Patients with blepharophimosis syndrome are more likely to develop amblyopia. The identificationand management of amblyopia should be integral to the treatment of congenital ptosis.

Severe unilateral congenital ptosis with poor levator function:tarsoconjunctival mullerectomy plus levator resection vs frontalis sling procedure

AIM:To compare frontalis sling and tarsoconjunctival mullerectomy plus levator resection(TCMLR)in subjects with severe unilateral congenital ptosis with poor levator function(LF).METHODS:A prospective non-randomized nonblinded single center clinical trial.Fifty patients with severe unilateral congenital ptosis with poor LF were recruited.The frontalis sling and TCMLR were performed and the functional,cosmetic outcomes,complications,and success rate were evaluated at 1,3,and 6mo postoperatively.The t-test,Chi-square,Fishers exact,and nonparametric MannWhitney tests were used by SPSS software.RESULTS:Frontalis sling and TCMLR procedures were performed on 26 and 24 patients respectively.The mean age was 10.97±10.67y.LF was significantly better in the TCMLR group at months 1,3,and 6(P=0.002).Lagophthalmos was more common in the TCMLR group(no significant difference).At month 3,mild punctate epithelial erosions were observed more in the frontalis sling group(P=0.002).Significant complete success rate of 1st and 6th month for the frontalis sling vs TCMLR groups were 50%vs 20.8%(P=0.02),and 38.4%vs 50%(P=0.03)respectively.CONCLUSION:Complete success rate of TCMLR is higher in long-term follow-up in contrast with the frontalis sling in the short-term.Transient complications are more detected in mid-term follow-ups in both groups.

Factors associated with corneal astigmatism change after ptosis surgery

AIM: To evaluate the predictive factors of postoperative corneal astigmatism change in ptosis patients who underwent ptosis surgical repair.METHODS: Patients who underwent levator resection at Oculoplastic service of the Department of Ophthalmology, Naresuan University Hospital, Thailand between September 2017 and August 2019 were retrospectively evaluated. Changes in degree and axis of corneal astigmatism after ptosis surgery were compared based on patient factors consisting of age at operation, sex, preoperative marginreflex distance(MRD) 1, and preoperative degree and axis of corneal astigmatism.RESULTS: Forty-two eyes of 28 patients were included in the study. Wilcoxon signed ranks test showed a significant postoperative corneal astigmatism change only in a subgroup of eyes with preoperative astigmatism of ≥1.5 diopters(D;P=0.006). Furthermore, 72.2%(13/18) of the eyes with preoperative astigmatism of ≥1.5 D showed a reduction of astigmatism after eyelid surgery, with the mean astigmatic change of 0.65 D. Majority of preoperative eyes demonstrated with-the-rule astigmatism pattern(45.2%), of which 57.9% showed a reduced degree of astigmatism.CONCLUSION: In patients undergoing ptosis surgery, the data demonstrate for the first time the association between postoperative corneal astigmatism change and a preoperative corneal astigmatism of ≥1.5 D. Thus, we encourage considering severity of corneal astigmatism prior to cataract or refractive surgery planning in ptosis patients, especially with toric-intraocular lens, to avoid the possibility of calculation error.

Clinical value of phenylephrine testing in the upper and lower eyelids of patients with aponeurotic and congenital eyelid ptosis

·AIM:To characterize the phenylephrine test in aponeurotic and congenital eyelid ptosis,to determine the appropriate timing of the phenylephrine test,and to assess the responses of the upper and lower eyelids.·METHODS:This was a retrospective analysis of 140 eyes of 87 patients(mean age 52.29±16.45 y;22 males,65 females)with upper eyelid ptosis.Totally 88.6%had aponeurotic and 11.4%had congenital ptosis.For the evaluation of the responses of the upper and lower eyelids to topical 2.5%phenylephrine,the scleral show height,the marginal reflex distance(MRD)between the inferior margin of the upper eyelid and pupillary light reflex(MRD1),and between the central portion of the lower eyelid and pupillary light reflex(MRD2)were measured at the 2^(nd),5^(th),and15^(th)minutes.The changes of MRD1 and MRD2 with time(ΔMRD1 andΔMRD2)were evaluated.·RESULTS:The mean MRD1,MRD2.and scleral show heights increased within 5 min after testing,remaining largely stable between the 5^(th)-15^(th)minutes.The percentage of eyes with a greater response in MRD1 increased with increased severity of ptosis(P<0.05).Eyes with aponeurotic ptosis were more responsive to phenylephrine testing than congenital ptosis.The mild ptosis group had lower scleral show measurements and higherΔMRD2 values.TheΔMRD1 andΔMRD2 values were poorly correlated in all measurement times.·CONCLUSION:Performing the phenylephrine test 5 min after instilling the reagent is adequate to assess the maximum response of the upper and lower eyelids.The upper and lower eyelid responses in phenylephrine testing are poorly correlated.However,theΔMRD2 is related with baseline scleral show degree that may be a postoperative predictive factor.Further studies are necessary to determine the relationship between the responses of the lower eyelids to phenylephrine testing.

Suprasellar cistern tuberculoma presenting as unilateral ocular motility disorder and ptosis:A case report

BACKGROUND Intracranial tuberculoma is a rare and serious type of tuberculosis,which mostly occurs in the frontoparietal and cerebellar hemispheres,with predominance in the gray-white matter junction area,while tuberculomas only in the cistern are extremely rare with only a few reported cases in the literature.We describe a unique case of isolated tuberculoma in the suprasellar cistern,with only right ocular motility disorder and upper eyelid ptosis.CASE SUMMARY A 5-year-old boy without any medical history presented with right ocular motility disorder and upper eyelid ptosis one month ago.He had no history of fever,headache,vomiting,convulsions,or limb weakness.Neurological examination showed right third cranial nerve palsy with restrictions of eye movements and ptosis,pupil dilation and negative light reflex.Imaging suggested a spaceoccupying lesion in the suprasellar cistern with calcification and ring-enhancement.Moreover,no Mycobacterium tuberculosis was found in cerebrospinal fluid by polymerase chain reaction(PCR).The lesion was initially diagnosed as a tumor,while postoperative pathology combined with PCR indicated tuberculoma.The patient continued postoperative anti-tuberculosis treatment.At present,the patient's condition is stable and the symptoms are partially relieved compared with those before surgery.CONCLUSION This case confirmed that isolated intracranial tuberculoma can occur in the suprasellar cistern.Therefore,for space-occupying lesions in the suprasellar cistern,tuberculoma should be included in the differential diagnosis even if there is no history or indication of tuberculosis infection.

Apoptosis of Leukemia Cells Induced by CD34^+ Cells Transferred Exogenous Fas Ligand

To assess the value of CD34 + cells transferred exogenous Fas ligand (FasL) in inducing apoptosis of human leukemic cells, the CD34 + cells transfected with F asL or without, pretreated with mitomycin C, was mixed with leukemic cell line U937 cells in presence or absence of daunorubicin (DNR) or cytosine arabinoside (Ara C). After l8 h, apoptosis of cells was detected by FCM and TUNEL. Induced for l8 h by CD34 + cells transfected with FasL or without, the ratio of apoptos is of U937 cells was (5.0±1.3) %, (10.8±0.6) % ( P < 0.01), respectively. Induced by FasL +CD34 ++DNR, FasL +CD34 ++Ara C, the ratio was (13.4±1.0) % ( P < 0.05), (17.9±1.3)% ( P <0.01), respectively. The result demonstrated that CD34 + cells transfected with exogenous FasL could induce apoptosis of human leukemic cells and showed a cytotoxic synergistic effect when used in combination with chemotherapeutic drugs, suggesting that it was possible to develop a new method in treatment of leukemia.

Acquired ptosis associated with oculomotor and contralateral facial nerve synkinesis： the first reported case

Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,

Evaluation of the Levator Palpebrae Superioris Muscle Plication in the Treatment of Ptosis (About 12 Cases)

Introduction: The ptosis is a fall of the upper eyelid in relation to a deficit of the levator device of this one. In practice, it poses two major problems, the first one is the eminent risk of amblyopia during severe congenital ptosis, and the second is of an aesthetic nature, representing the main reason for consultation. The aim of this work is to evaluate the interest of the levator palpebrae superioris muscle plication in the ptosis surgery. Materials and Methods: We collected 12 patients who received a correction of their ptosis by plication of the levator palpebrae superioris muscle over a period of 3 years from January 2012 to December 2014. Result: The mean age at treatment was 22 years;the ptosis was congenital in 8 cases, and acquired in 4. The ptosis was major in 67% and moderate in 33% of the cases. Muscle plication was the basic surgical technique in all patients in our series. The function and aesthetic results were satisfying in 6 cases (50%), good in 4 cases (34%), acceptable in 1 case and bad in 1 case (8%). Discussion: The comparative study has shown that the plication of the levator palpebrae superioris muscle is a possible alternative for the correction of ptosis whatever the type of ptosis with results comparable to the reference technique compared to the degree of correction, whereas the operative follow-up is simpler and more minor complications. Conclusion: The surgical treatment of ptosis should be done after a systematic clinical examination and after very precise indications. However, the plication of the levator muscle of the upper eyelid has shown its functional and aesthetic efficiency in congenital ptosis and in the ptosis of the adult.

X-Linked Dominant Congenital Ptosis Cosegregating with an Interstitial Insertion of a Chromosome 1p21.3 Fragment into a Quasipalindromic Sequence in Xq27.1

Blepharoptosis (ptosis) is defined as the abnormal drooping of the upper eyelid and is a feature of many conditions. It can be in isolated or syndromic form, bilateral or unilateral and congenital or acquired. Previously we have carried out linkage analysis on a family with dominantly inherited congenital bilateral isolated ptosis and found the condition to be linked to a region of approximately 20 megabases of chromosome Xq24-Xq27.1 with a cumulative LOD score of 5.89. We now describe further analysis using array comparative genomic hybridisation (array CGH), fluorescence in situ hybridisation (FISH), long range PCR and sequencing. This has enabled us to identify and characterise at the level of DNA sequence an insertional duplication and rearrangement involving chromosomes 1p21.3 and a small quasipalindromic sequence in Xq27.1, disruption of which has been associated with other phenotypes but which is cosegregating with X-linked congenital bilateral isolated ptosis in this family. This work highlights the significance of the small quasipalindromic sequence in genomic rearrangements involving Xq27.1 and the importance of comprehensive molecular and molecular cytogenetic investigations to fully characterise genomic structural complexity.

Unilateral Ptosis in a Child with Wilm’s Tumor Induced by Vincristine

Vincristine is a chemotherapy drug belonging to the group of Vinca alkaloids which also includes vinblastine and vindesine. It is used in hematological malignancies and solid tumors. The Vinca alkaloids are neurotoxic, usually causing peripheral neuropathy, and rarely cranial neuropathies. We report a case of a 33-month-old male child diagnosed with Wilms’ tumor, who had an isolated unilateral right ptosis following vincristine, with a good improvement after stopping it.

Treatment of congenital ptosis

Congenital ptosis is an abnormally low position of the upper eyelid,with respect to the visual axis in the primary gaze.It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral.Additionally,it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations.Depending on how much it interferes with the visual axis,it may be considered as a functional or a cosmetic condition.In childhood,functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated.However,even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised,albeit on a less urgent basis.Although,patching and glasses can be prescribed to treat the amblyopia,the mainstay of management is surgical.There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid.The first part of this paper will review the different categories of congenital ptosis,including more common associated syndromes.The latter part will briefly cover the different surgical approaches,with emphasis on how to choose the correct condition.In spite of many complex factors inherent to the treatment of congenital ptosis,the overall outcomes are quite satisfactory,and most surgeons feel that ptosis management can be both challenging and rewarding at the same time.

The Effect of Vault on Conjunctiva Combined with Fascia Sheath Suspension on the Mobility and Aesthetics of Eyelid in Patients with Ptosis

Objective:To investigate the effect of vault on conjunctiva combined with fascia sheath suspension on the mobility and aesthetics of eyelid in patients with ptosis.Methods:A total of 80 patients with ptosis who were admitted to our hospital from January 2017 to January 2019 were selected as the subjects.They were divided into 2 groups with random number table method,40 cases each.The control group was treated with modified single-incision frontalis fascia flap suspension,and the observation group was treated with vault on conjunctiva combined with fascia sheath suspension.The eyelid margin activity,aesthetics and complications were compared between the two groups.Results:The eyelid margin activity of the observation group after treatment was higher than that of the control group,the difference was statistically significant(P<0.05);the aesthetic satisfaction of the observation group after treatment was 95.00%(38/40)higher than that of the control group 70.00%(28/40)The difference was statistically significant(P<0.05);the incidence of complications in the observation group was 2.50%(1/40)lower than that in the control group 20.00%(8/40),and the difference was statistically significant(P<0.05).Conclusion:Patients with ptosis are treated with superior conjunctival fornix combined with fascia sheath suspension,which can improve the mobility of eyelid margin,and it is more beautiful and has less complications.

Breast ptosis correction with a knitted polypropylene mesh

Objective To evaluate a knitted polypropylene mesh used for mammapexy in correcting the breast ptosis. Methods Twenty-one patients with the mild or moderate breast ptosis were undergoing the mammapexy with a knitted polypropylene mesh. The operation was performed through the periareolar incision and a monofilament knitted polypropylene mesh was subcutaneously implanted on the surface of the gland and fixed up-ward. Results All of the patients were satisfactory of the appearance with the follow-ups from 2 to 16 months. No secondary ptosis, hypemophic scars and foreign body reactions were found. Conclusion The above-mentioned technique could be a good, safe and reliable method for correcting breast ptosis. 13 refs,3 figs.

Accurate Application of the Levator Palpebrae Superioris Anterior Migration and Shortening Technique in Blepharoptosis Correction Surgery

Background Accurate preoperative evaluation of the levator palpebrae superioris(LPS)strength is required for specific calculation of anterior migration or shortening.This information serves as a surgical reference for more accurate correction of ptosis.Methods Between June 2017 and June 2019,155 eyes of 97 patients were studied.Patients were divided into the following 3 groups based on the ptosis degree:mild(28 cases),moderate(53 cases),and severe(16 cases).The LPS strength was evaluated preoperatively and used to calculate LPS anterior migration and shortening.The LPS aponeurosis and Müller’s muscle(L-M)complex was separated from the upper margin of the tarsal plate to the calculated height according to the levator muscle suspension system retention approach.The complex was subsequently fixed to the planned tarsal plate location.The upper eyelid margin(UEM)height,eyelid morphology,eyelid closure,eye symmetry,exposure keratitis status,and patient satisfaction were evaluated at 1 week and at 1 and 6 months postoperatively.Results In all cases,the UEM positions were normal,and only patients with severe ptosis exhibited lagophthalmos in the early posterative period.Six months postoperatively,13%of eyes in the severe group had residual ptosis;all mild and moderate cases exhibited good surgical outcomes.The eyelids closed well with no exposure keratitis.All patients were satisfied with the eyelid contour.Conclusions Accurate LPS anterior migration and aponeurosis shortening can eliminate various factors affecting surgical blepharoptosis treatment.These procedures not only reduce operation time but also enhance the stability of postoperative correction.

Validity and reliability of the Ocular Motor Nerve Palsy Scale

Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index（CVI） and factor analysis were used to analyze the scale＇s construct validity. The intraclass correlation coefficient and Cronbach＇s alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results（I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K＊ = 1） indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965（P 0.01）, a test-retest reliability intraclass correlation coefficient of 0.976（P 0.01）, and Cronbach＇s alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry（registration number： Chi CTR-OOC-17010702）.

Expander implantation for correction of high-riding nipple with enlarged nipple-areola complex using revision mastopexy: A case report

BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.