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The levator aponeurosis. Attachments and their clinical significance.

A detailed knowledge of the anatomy of the levator aponeurosis is required for the aponeurotic approach to ptosis. Yet, many misconceptions regarding the insertional attachments of this important structure are found in the literature. The levator aponeurosis inserts via a fan of fibers. The first insertional attachment curves anteriorly around the orbital septum to form the lid crease. Approximately the anterior half of the aponeurosis inserts into pretarsal orbicularis and the overlying subcutaneous tissue. The remaining posterior half inserts firmly on the lower portion of the tarsus.